STATE HOUSE – Rep. David Morales and House Minority Leader Michael Chippendale have introduced bipartisan legislation (2023 H-5350) to limit the out-of-pocket expenses of specialty prescription drugs for insured people to $150 per 30-day supply.

“Across Rhode Island, over 600,000 of our neighbors suffer from at least one chronic disease and an estimated 249,000 have been diagnosed with two or more chronic diseases, of which, 7,000 are cancer patients. So unfortunately, our state is home to thousands of community members diagnosed with chronic conditions which threaten their lives and make them more likely to depend on specialty drugs during their lifetime. Therefore, it is the responsibility of our state government to ensure that all our people, regardless of socioeconomic status, are able to afford these lifesaving drugs because access to these prescriptions can literally mean the difference between life or death,” said Representative Morales (D-Dist. 7, Providence). “And while I have introduced similar legislation over the past two years, I believe this is the time that we’ll pass this bill into law and finally lower the costs of prescription drugs given the broad support we have from the Office of the Health Insurance Commissioner, Democratic and Republican legislators and most importantly, working people who are being hurt by high-cost prescription drugs.”

Prescribed specialty drugs are defined, priced and classified by Pharmacy Benefit Managers as complex oral or injectable medications used to treat chronic conditions, such as cancer, hemophilia and arthritis. Most specialty medications are lifesaving prescriptions that patients must take regularly for years. But even with insurance coverage, co-payments can be as high as $2,500 per month, forcing some families to choose between saving the life of their loved one or financial ruin. A 2016 report from the AARP found that 25% of Rhode Island residents stopped taking their prescribed medications due to high costs.

“When faced with a serious medical issue, families have enough to deal with,” said Minority Leader Chippendale (R-Dist. 40, Foster, Glocester, Coventry). “They can’t afford spending thousands of dollars a month on necessary prescriptions on top of the thousands they are already paying for insurance coverage.”

Pharmaceutical companies often own the patents of specialty drugs, which give them a monopoly on these vital treatments. Consumers have no ability to negotiate prices or seek alternatives, allowing companies to charge higher rates each year. One glaring example is Revlimid, a medication used to treat cancer that was approved by the FDA in 2005. The medication originally cost $215 per pill. The company, Celgene, has since raised the costs more than 20 times, and one pill is now $763. Many cancer patients are prescribed Revlimid for daily use.

In 2020, the U.S. House Committee on Oversight launched an investigation to understand the price increases of Revlimid and found that the increased costs were not due to research and development or modifications to the drug. Instead, they found, prices were raised in the pursuit of greater profit for the company. 

“Many patients living with cancer rely on these lifesaving drugs that cost $100,000 or more. In many cases, even patients with insurance spend thousands of dollars each year on their medicine. Lives are on the line. Nearly half of cancer patients taking oral chemotherapy stop when their out-of-pocket costs exceed $2,000. They simply can’t afford it. Rhode Islanders shouldn’t have to choose between food, housing, and life-saving medications. With the passage of this bill, they won’t have to,” said Jen McGarry, Rhode Island Leukemia and Lymphoma Society Advocacy Director.

Several states such as Delaware, Louisiana, New Jersey and Maryland have passed similar legislation capping out-of-pocket expenses for specialty medications at $150 per 30-day supply. Representative Morales and Leader Chippendale are hopeful Rhode Island will join them this year.

“Our loved ones did not choose to get sick,” Minority Leader Chippendale said. “They should not face financial ruin in order to take their life-saving medicines.”