House OKs discount drug measure

Health care was on the agenda in key votes taken in the New Hampshire House and Senate earlier this month.

In the House, lawmakers voted overwhelmingly March 6 for a bill that would force pharmacy companies to offer discount drugs to the uninsured or risk being taken off Medicaid’s preferred drug list.

The Senate passed a bill March 8 that would require private insurance companies to cover early intervention services, over the objection of some Republicans who complained that it would raise insurance premiums.

House Bill 628 would establish a program similar to one in Maine and would leave many of the details of setting it up to the state Department of Health and Human Services, which would actually negotiate the discount for anyone who is uninsured and earning less than 350 percent of the poverty level.

Those people would get a discount card, which participating pharmacists could honor. The state would get a rebate that it could then share with the participating pharmacists and would reimburse them for selling the discounted drugs, though not the cost of dispensing them.

Supporters argued that, since insurance companies (including Medicaid), negotiate discounts, the uninsured end up being the only ones paying full freight, actually subsidizing those who can afford health insurance.

“To ask people who can least afford it to pay the highest costs for medicine is neither prudent or fair,” said Rep. Cindy Rosenwald, D-Nashua, a co-sponsor of the bill.

But drug manufacturers have opposed the measure’s “hammer” provision, which would take the drugs off the state’s preferred drug list, forcing providers to seek pre-approval before prescribing them to Medicaid recipients.

“This amounts to extorting rebates from drug manufacturers,” argued Rep. Fran Wendelboe, R-New Hampton.

The problem, she said, is that these drugs would no longer be available to Medicaid recipients – the state’s poorest citizens.

Drug manufacturers are already offering free and discount drugs to the uninsured, she said, and this will create a bureaucracy to run the program. A previous version of the bill said it would cost some $3 million a year.

However Rep. John DeJoie, D-Concord, the bill’s prime sponsor, called that previous estimate inaccurate, and most manufacturers are only discounting high-priced drugs that they are trying to market, not the generic drugs that uninsured people really need.

Michael Smith, president of the New Hampshire Pharmacists Association, also said he has concerns about the measure because the initial bill left it up the discretion of Health and Human Services to share the rebate with them.

The House did pass an amendment to the bill that seems to require rebate-sharing, but he wasn’t sure if pharmacists would still be subsidizing the discount.

He also noted that the cost of dispensing medication averages about $10 a prescription, and the state won’t cover that.

DeJoie said that the bill’s supporters will continue to address the concerns of drug manufacturers and pharmacists as the bill moves through the House Finance Committee.

While one opponent asked for a roll call vote, not enough representatives seconded it, apparently not anxious to go on record against drug discounts. The bill passed on a “division vote,” through which individual votes are not made public, 257-95.

Under the Senate measure, early intervention coverage would benefit primarily those with developmental disabilities under age of 3, after which school districts start to pay for such services.

Supporters argued that the cost would be minimal, less than a third of a percent of a policy’s premium, and that would be more than offset by savings to insurers as well as the schools and Medicaid, which can avoid more costly interventions later on.

Opponents pointed to a last-minute estimate from the state Insurance Department that said the state’s insurance bill would increase by more than 6 percent if the bill passes. They also noted that Anthem, the state’s largest insurer, already provides the coverage, and this would only limit the chance of those without children to buy cheaper insurance.

“Here we are mandating more cost to the insurance companies,” said Sen. Robert Letourneau, R-Derry.

But supporters countered that most employees don’t make that choice — their employers do.

“Most people don’t have a true choice of where they purchase their insurance from,” said Sen. Margaret Hassan, D-Exeter.

In the end, the Senate approved the measure on a voice vote and sent it to the Senate Finance Committee, which will try to figure out why cost estimates differ so much.

Other measures

In other action taken earlier this month in the House, lawmakers:

• Passed a bill that would substantially raise solid waste fees in order to pay for hazardous waste cleanups. A permit fee for a cleanup operator, for instance, would increase from $5,000 to $7,500. Large generators would pay a quarterly fee of 6 cents a pound for unrecycled hazardous waste. Brownfields programs participation fees would rise from $3,000 to $4,500. Groundwater management permit fees would double to $2,000.

No one spoke out against the bill on the House floor, and it passed, 232-111, in another division vote and is on its way to the House Ways and Means Committee.

• Killed a proposal to dedicate 4 percent of rooms and meals tax revenues to close the Department of Fish and Game’s deficit. The bill would have diverted $4.7 million a year from the $120 million rooms and meals revenue stream. Supporters said that the department, which has historically been self- supporting, has been struggling since revenue from fees have been decreasing.

• Rejected on a 220-113 vote a bill to lease the state-owned Cannon Mountain ski area.

Supporters of the bill, including Rep. Fred King, R-Colebrook, argued that Cannon is losing money, unlike Mt. Sunapee, which been privately run for several years. While the state keeps on promising to upgrade Cannon so it will make money, “ski areas take a back seat to prisons and schools. We need to turn this over to the private sector.”

But opponents argued that with the ski industry in such difficulty, this is not the most advantageous time to negotiate a long-term lease — besides, the state needs to complete a long-term study.

In the Senate, lawmakers passed a bill over to the House that would require any organization that offers architectural services to be certified by the state.

Supporters said that some firms without licensed architects have been advertising such services. Opponents were worried that homeowners or small contractors couldn’t make simple drawings without hiring an architect, but supporters said that wasn’t the intent of the bill.