Is international prescription drug pricing the next step for Florida?

TALLAHASSEE, FLA. 9/22/21-Rep. Randy Fine, R-Palm Bay, during the House Redistricting Committee, Wednesday at the Capitol in Tallahassee. COLIN HACKLEY PHOTO

On the eve of the 2024 Legislative Session and three days after the state received approval for a Canadian Drug Importation program, a leading House Republican announced his plan to lower prescription drug costs.

House Health and Human Services Committee Chairman Randy Fine filed legislation (HB 1431) to establish “international reference pricing” for drugs, essentially limiting prescription drug prices in Florida to those paid by other countries, including those with socialized health care.

On Monday, Fine held a two-hour meeting and scheduled presentations by policy experts to lay the groundwork he hopes will translate to support for the bill.

“The fundamental premise of what we’re here to talk about today is whether Americans should subsidize the drugs of people in other countries. And so we’re going to talk about the idea of how drugs are priced in the United States, how they’re priced around the world. And again, that notion of, should Americans pay more for their drugs?” Fine said.

Florida has taken steps in recent years to try to lower prescription drug costs. The Legislature in 2019 approved a Canadian Drug Importation Program. And at the behest of Gov. Ron DeSantis, who is running for president and needs a victory on the prescription drug front, lawmakers in 2023 passed far-reaching legislation (SB 1550). The law also changed the rules regarding pharmacy networks, a significant victory for independent pharmacists.

Though he ultimately voted for final passage, Fine in 2023 questioned whether the legislation would save money. It was a sentiment he repeated Monday.

“Last Session, you’ll remember we spent a lot of time talking about prescription drugs. And we had a lot of debates, and we heard a lot of bills and things like that. But at the end of the day, with all of that work, there was nothing in any of those bills that would actually cut prices for consumers. All we did was kind of move silverware around on the table.”

Fine’s bill has garnered lobbying interest from Astellas Pharma US, Bristol-Myers Squibb Company, Johnson & Johnson Services, Otsuka America Pharmaceutical, and the Pharmaceutical Research and Manufacturers of America, or PhRMA.

Stami Williams, PhRMA director of state public affairs, issued a statement Monday saying that Fine’s proposal would jeopardize patients’ access to medicine and could shift research and development away from the United States.

“There are meaningful policy solutions that can help lower medicine costs for Florida patients at the pharmacy counter, including requiring insurers and their pharmacy benefit middlemen to share the massive rebates and discounts they get from biopharmaceutical manufacturers with patients at the point-of-sale,” Williams said.

“Rebate reform is a great first step to make sure patients never have to pay more than their insurers for their medicines.”

Legislators are also reviewing legislation to ban copay accumulator programs, a scheme where PBMs and insurance companies accept copay assistance payments made on behalf of patients but do not apply such copay assistance payments to the patient’s deductible, out-of-pocket maximum, or co-payment responsibility.

Meanwhile, Andrew Mulcahy, Senior Policy Researcher, RAND Corporation and Drew Gattine, Senior Policy Fellow, National  Academy State Health Policy made presentations to the committee.

Mulcahy shared with the committee the findings of a 2021 peer-reviewed report that compared drug prices in the United States with 32 other countries. The findings show U.S. prices were 3.44 times higher than nations. Prices for generic drugs — which account for 84% of drugs sold in the United States by volume but only 12% of U.S. spending — are slightly lower in the United States than in most other nations.