House OKs discount drug measure

The New Hampshire House overwhelming voted for a bill Tuesday that would force pharmacy companies to offer discount drugs to the uninsured or they will be taken off the Medicaid’s preferred drug list.

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 on Tuesday 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.

In other legislation, the House 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.

Supporters said that the measure would spread the state’s Superfund costs, but Rep. Steve Vaillancourt, R-Manchester, opposed it in committee, arguing these hefty increases are an unfair burden on the industry, and if the state really wanted to spread the cost out, it should use the general fund to pay for cleanups.
But 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. – BOB SANDERS