CVS Health has asked Governor Phil Scott to veto H.353 — a last-ditch effort to freeze a bill it believes would increase the cost of prescription drugs for Vermonters with private insurance.
H.353 began as a bill to make drugs more affordable by regulating pharmacy benefit managers, outside companies that negotiate drug coverage plans for consumers with private insurers. But revisions to the bill, as it made their way through the House and Senate, would have virtually guaranteed that specialty drugs given to health care patients, including expensive cancer medications, would be filled at the University of Vermont pharmacy. HealthNetwork. in Burlington, rather than through cheaper mail-order pharmacies preferred by insurers.
Though the language was softened somewhat in subsequent revisions, the final draft of the bill, approved Wednesday in the dwindling hours of this year’s legislative session, still gives UVM Health Network an edge when it comes to filling those expensive prescriptions.
In its letter to the Scott Administration Friday, CVS Health said the bill “includes a special arrangement that allows hospitals to raise specialty drug prices for patients with rare and complex conditions.”
Jason Maulucci, Governor Phil Scott’s press secretary, said the governor has not yet made a decision on the matter.
“We support targets to reduce costs for consumers, but we have not yet received the bill, and once we do, it will go through our thorough review process before the governor makes a decision,” Maulucci wrote in an email.
CVS Health has a pharmacy benefits management company that does business in Vermont. The company argued that H.353 would cost individual patients hundreds of dollars a year.
Jeff Hochberg, president of Vermont Retail Druggists, said CVS Health’s concerns are unfounded. According to Hochberg, the bill simply redirects prescription money from pharmacy benefit administrators to local pharmacies. Patients, he said, would not see an increase in their premiums as a result.
“Encoding money out of the state into three publicly traded companies does nothing but maintain steady upward pressure on pharmaceutical costs,” Hochberg said.
Specialty prescriptions — a broad category that includes everything from Botox to biologics — are a relatively new addition to a doctor’s arsenal. Patients usually receive these drugs in a clinic or other healthcare facility through a monthly infusion or injection. Because these drugs can cost thousands of dollars for a single dose, insurers provide them sparingly and only after patients and their doctors have exhausted all other options.
The bill could be a financial boon to UVM Health Network. For example, a single dose of Herceptin, a biologic drug to treat esophageal and breast cancer, costs more than $10,000 when delivered to a hospital pharmacy, according to the national insurance trade group AHIP. The same drug costs about $6,500 at a doctor’s office and $4,600 at an independent pharmacy.
Private insurers objected that the legislation would force them to pay for more drugs dispensed at the state’s only commercial specialty pharmacy, the UVM Health Network pharmacy in Burlington.
A spokesperson for the UVM Health Network was not immediately available for comment
Significantly, the bill would allow the state’s Medicaid program to purchase and ship specialty drugs by mail through Rutland Pharmacy, the only specialty pharmacy partnered with this public insurer.
Rep. Mari Cordes, D/P-Lincoln, who sponsored the bill in the House, previously said she would like to change the portion of the bill that gives UVM Health Network an advantage when it comes to specialty drugs.
Cordes was not immediately available for comment Friday morning.
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