Straight from Salem: Breaking down March legislative hearings on prescription drug costs

Chief sponsors for all of these bills testified on their behalf. Rep. Wallen affirmed her commitment to lowering drug costs in Oregon with SB 764, and Rep. Hudson shared his excitement to vote on both 763 and 764 when they reach the House. Sen. Patterson also submitted written testimony in support of these two bills. Finally, Rep. Rachel Prusak (D-Tualatin) testified in support of SB 844, arguing that groups across the board should be able to come together to make the proposed solutions work and bring down the cost of prescription drugs.

Representatives from three advocacy organizations testified in support of SB 763 and SB 764: Dave Hunt from the Oregon Coalition for Prescription Drugs, OSPIRG State Director Charlie Fisher, and Dan Torres from Oregon AFSCME. “OCAP is really a broad coalition . . . of groups who frankly are often before your committee fighting about a whole variety of things. But when it comes to these two bills, they’re 100% on the same page,” Hunt said. Both Fisher and Torres echoed Hunt’s sentiments, arguing that more than transparency is necessary when it comes to holding pharmaceutical companies accountable and adding that higher prescription drug prices not only affect consumers but also government agencies that provide medication to citizens. 

Akil Patterson, a political organizer with the Oregon Nurses Association who testified in support of SB 844, criticized pharmaceutical industries for lobbying against the bill. “Every other industry has shown that they are willing to work with us and work through this process, except the major pharmaceutical companies,” he said. Patterson, who has worked in health care advocacy across the country, helped pass a similar bill in Maryland in 2019 and argued that bringing down costs would increase equity in Oregon.

In both hearings, the Committee had the opportunity to hear from several constituents who described their experiences with the healthcare system and their personal reasons for supporting the three bills. On March 3rd, Joan Morgan testified in support of SB 763 and SB 764, explaining that she serves as a primary caregiver for her father, who is suffering from late-stage cancer and has seen a $7,000 spike in his medication over the past few years. “When it comes to my father’s medication, there is no price I wouldn’t pay,” she said. “Drug manufacturers know this, and so do their sales representatives. As a consumer, I’m horrified to learn that there’s currently no way to know how pharmaceutical sales reps are operating here in Oregon . . . [and] if I knew that a company was being persuaded by another to delay the release of a more affordable option for his medication, I can’t even express how upset I would be.”

Michael Nielsen of Bend and Cameron Locklear of Newport submitted testimony for both hearings. Nielsen explained to the Committee that his wife was diagnosed with Hepatitis C several years before but the family wasn’t able to find the treatment that she needed – the drug that she was prescribed was set at $13,000 for a 30-day supply. “It took me a year of jumping through frustrating hoops to secure outside funding for my wife’s drug. During that time she had to go without and her body began to pay the price,” he said. Locklear, a 24-year-old, described his own struggle with affording insulin for his Type 1 diabetes, a disease he’s had since middle school. “It’s terrifying to know that I work sometimes 56 hours a week, and still can’t afford to buy insulin for myself,” Locklear wrote. “I’m very thankful and appreciative to my family for their continued support, but even then it’s sometimes not enough. I often find myself only eating one meal a day.”

Several experts in health care and health care policy testified at both hearings, answering questions from committee members and providing rebuttals to opposition arguments. On March 3rd, the Committee heard support for SB 764 from Professor Robin Feldman of the University of California Hastings College of Law. Feldman has written extensively on health care policy and law and even testified in front of Congress on similar issues. Furthermore, Dr. Sean Jones and Dr. Sameer Awsare, both from Kaiser Permanente, testified in support of both bills and argued that medical care should be based on science rather than sales pitches and urged the Committee to pass what Jones referred to as “common sense legislation.”

On March 22nd, expert testimony came from Andrew York, a current member of the Maryland Prescription Drug Affordability Board. Maryland’s PDAB was passed in 2019 and has the same goal of lowering prescription drug prices for consumers in the state. The Committee also heard from Jane Horvath, a national health policy analyst who has helped shape and pass prescription drug affordability bills in several other states. Horvath explained that a PDAB in Oregon would benefit consumers tremendously, and remained in the hearing to counter some of the opposition arguments as described below.

Although the majority of the March 3rd testimony was in support of SB 763 and SB 764, the Committee also heard two voices in opposition. Asher Lisec of PhRMA (a trade group representing pharmaceutical companies), expressed concerns with both bills, arguing that SB 763 ignores existing federal transparency guidelines and raises First Amendment questions by forcing sales representatives to use “specific speech.” Lisec also questioned the efficacy of SB 764, arguing that restricting patent settlements could actually lead to higher costs for consumers and runs contrary to United States Supreme Court rulings.  In reality, SB 763 contains no speech restrictions and creates regulations very similar to the standards already in place for lobbyists, and SB 764 only restricts anti-competitive patent settlements. Moreover, the Supreme Court case referenced by Lisec doesn’t establish any framework for whether a settlement is anticompetitive – in fact, it allows lawsuits against this kind of settlement. Brett Michelin from the Association for Accessible Medicines, a pharmaceutical company representing generic and biosimilar manufacturers, also testified in opposition to SB 764, contending that without settlements, generic brands find themselves tied up in litigation and therefore lose the chance to get their products on the market at all. However, SB 764 doesn’t prevent court settlements in general – instead, it prohibits ones that encourage monopolies and anticompetitive markets for prescriptions.

Far more opposition voices arrived to testify against SB 844, from both pharmaceutical industries and medical providers. Lisec returned on PhRMA’s behalf, arguing that upper payment limits on medications wouldn’t solve the problem of drug affordability for patients, who would still face insurance copays on each prescription. Horvath rebutted these claims during her testimony, pointing out that upper payment limits would travel through the supply chain and eventually reach the patient and their insurance bill, maintaining the lower cost through every step in the process. “I think PDAB will have to work closely with insurance companies to ensure that patients with copays will benefit as well,” she added.

Representatives from organizations such as the Oregon Bioscience Association and the Biotechnology Innovation Organization also raised concerns about the impact that payment limits would have on funding for research and development of new medications, and therefore patient access to these drugs. However, Horvath pointed out that pharmaceutical companies have enormous margins in revenues that won’t be affected by upper payment limits. “In my view, the only reason people will no longer have access [to medication] is because pharma will retaliate, boycott, and take patients hostage, essentially,” she said.