HAPPY ENDING!

I belong to a group that tries to promote the New York Health Act (NYHA) by what it calls "Direct Action" -- e.g. public demonstrations, etc. Recently, when discussing a possible demonstration against a pharmaceutical maker, the leader of the group said, "We want to be able to tell the people that with NYHA, drug costs would be contained." He looked in my direction and asked, "did I hear you volunteer to research what is contained in the Act in this regard?" Actually, he didn't hear me say it, but I got the message. "Sure Bob," I replied, I'll be glad to."  I figured that  the text of the Act -- A4738/S4540 -- is available on line, so I ought to be able scan the text for some reference to drug price limitation or containment.

But it turned out I couldn't. Except for language about helping with insurance premiums for the poor, there was nothing I could find. I was horrified: What sort of healthcare reform was this NYHA where I could find no mention of drug cost containment? Regretfully, at the next meeting I had to inform Bob that there as no mention of it that I could find.

Bob was very tactful: "Your findings," he said, "are not accurate. Look: in the Campaign's FAQ page it says that through bulk purchasing, New York Health will buy drugs and medical supplies at lower, negotiated prices. And Katie [Katie Robbins of the NYHA campaign and the New York Nurses Association] would never put in something like that unless it were absolutely true."

I was thrilled to hear it, but uneasy that I couldn't find it anywhere in print. So after the meeting, I sent off a slew of emails, and, to make a long story short, finally received an answer from a very distinguished dude, one Len Rodberg, who wrote:

Drug purchasing and prices are handled in the NYHealth Act in Sect. 5105, Part 4(c) which refers to Article 2-A of the NYC Public Health Law. (That’s the way legislation works, unfortunately!) That law set up the Preferred Drug Program under which the State has been purchasing drugs for the Medicaid program getting large (33%) discounts. It is described very clearly in the attached policy brief which Gottfried wrote several years ago. I think it will answer any questions. 

In other words, the NYHA text refers to another law, already passed -- the Preferred Drug Program -- through which New York State is currently able to purchase at a steep discount drugs for a small subset of its Medicaid program -- the fee-for-service plans -- covering a relatively few 4 million people. It used to be employed for the entire medicaid population until Cuomo got passed a provision eliminating patients in managed care plans from the program, leaving only patients in the fee-for-service plans -- a juicy gift to Big Pharma. What the NYHA would do is "piggyback" onto the PDP plan, increasing the "covered lives" from 4 million to some 20 million, thus dramatically increasing the state's bargaining power. With this increased bargaining power, it would not surprise me that the state would enjoy discounts far exceeding 33% -- which would be, in Shakespeare's words, "a consummation devoutly to be wished."

All we need is the political will to make this happy ending real.

Dio

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