Karen Ferguson: Legislature’s prescription drug bill threatens patient health

By Karen Ferguson

After a nearly 20-year career at Arthritis NW, one of the largest rheumatology clinics in the Pacific Northwest, I am deeply disappointed to see Washington State proposing legislation that would shift patients from prescribed medications by their doctor to less effective treatments. If passed into law, Senate Bill 5532 will certainly save the government money because fewer chronic disease patients will be able to access their medications, but it will come at a high cost to the most vulnerable patient communities. vulnerable in Washington State and to the clinicians who serve. them. I would expect draconian cost-cutting behavior from insurance companies and their corporate pharmacy benefits networks, but not from the public servants who represent our communities in the Assembly legislative.

SB 5532 would establish a board of five unaccountable administrators who would be responsible for deciding which drugs the state will purchase and make available to patients through a so-called “upper payment limit.” Essentially, if the state deems a drug too expensive, patients will be forced to switch to a cheaper drug in the same class. SB 5532 makes the false presumption that drug choice is “one size fits all” and incorrectly asserts that all drugs in the same class work equally well for all patients with the same disease.

Clinicians who treat patients with complex chronic conditions know that switching non-medical medications is as dangerous as it is absurd. Moving a stable patient to a different therapy in an effort to achieve greater savings is typical profit-seeking behavior for insurance companies and their corporate PBM networks; it’s frustrating to see lawmakers in Washington considering form restrictions and non-medical switching tactics.

Rheumatoid arthritis affects more than one million American adults and nearly 1% of the entire world population. It disproportionately affects women and can cause debilitating pain. Each patient is unique in their medical history and needs, and patients often try different medications in the same class before identifying the best one for them. Taking drugs away from patients will cause direct harm, while driving up other costs in the health care system. Patients who do not have access to their prescribed therapies end up needing more invasive and expensive treatments over time.

By creating an “upper payment limit” for certain drugs, SB 5532 would handcuff pharmacists, health care providers, hospitals, and institutions in Washington, who would no longer be able to administer certain drugs – regardless of how much they could change the patient’s life.

If a health care provider typically purchases drugs from entities outside of Washington, they may not be able to access drugs at or below Washington’s “upper payment limit.” This would force providers to stop purchasing certain drugs, as they would be overwhelmed with drug costs. We cannot expect clinicians to provide treatment at a cost lower than what it takes to acquire and administer this drug.

If a patient is in desperate need of a prescription that has been excluded from Washington’s approved list, they may have to travel out of state for treatment, which is especially distressing for patients with mobility issues or those who depend on public transport. While patients can request a grievance waiver through their health plan to appeal board decisions on a case-by-case basis, for-profit insurance companies still monitor outcomes and what constitutes a necessity. medical.

Moreover, we know that such grievance processes create structural barriers to accessing care. Most patients have their hands full managing their own condition while caring for their families and will not go through a lengthy appeal process to access medications their doctor has already prescribed. It is unfair to place arbitrary administrative barriers between patients and the medications they need.

While I agree that greater transparency and fairness are needed in the drug supply chain, SB 5532 fails to address out-of-pocket patient charges at the pharmacy counter and instead imposes on clinicians and communities the burden of filling the gaps as resources are withdrawn. .

Karen Ferguson is the founder of Our Stories Rx, an interactive storytelling platform that elevates the voices of communities impacted by structural gaps in healthcare delivery systems. Ferguson lives in Spokane.