Health and Human Services (HHS) Policy Committee

A RESOLUTION ON REMOVING BARRIERS TO VALUE-BASED ARRANGEMENTS

WHEREAS, the United States spends substantially more on health care services than any other country in the world but has poorer healthcare outcomes;

WHEREAS, the United States spends less on prescription drugs as a percentage of overall health care spending than the overwhelming majority of countries that compose the Organization for Economic Co-Operation and Development (OECD), a forum where the governments of 34 democracies with market economies work with each other, as well as with more than 70 non-member economies to promote economic growth, prosperity, and sustainable development;

WHEREAS, aside from helping to prevent, treat, and cure disease, medicines also generate downstream costs savings by avoiding other expensive medical services; for example, for every 1 percent increase in medicine utilization, total Medicare program costs fall by 0.2 percent;

WHEREAS, many health conditions, from mental health to cancer, are ripe for development of more effective drug therapies and innovation must be incentivized to bring these new breakthrough drugs to market;

WHEREAS, while medicines bring good value to the health care system and close to 90 percent of medicines dispensed today are generics, newer therapies that reflect advances in innovation may have a higher price;

WHEREAS, different patients respond to drug treatments differently, and insurers are often averse to the risk of paying for new high cost therapies when outcomes are not guaranteed and members frequently change health plans;

WHEREAS, traditional reimbursement models and restrictive benefit designs can threaten patient access to new therapies, which can have a direct impact on a patient’s health and generate more downstream costs to the health care system;

WHEREAS, the consensus of the health care community is that the health care system must move from simply paying for services to paying for health outcomes;

WHEREAS, several insurers and drug manufacturers are interested in and are actively working on value-based reimbursement models that pay for better outcomes instead of just the dispensed therapy; and

WHEREAS, while value-based arrangements are one solution that can lead to greater care and efficiencies for all, there are statutory and regulatory constraints that threaten the ability of drug manufacturers to enter into value-based payment arrangements.

THEREFORE BE IT RESOLVED, that the National Black Caucus of State Legislators supports  and that regulators review current statutory and regulatory provisions that may impact the ability of drug manufacturers and insurers to develop and implement value-based contracting models, including regulations around Medicaid rebate calculations, application of anti-kickback statutes, permissible communications between drug manufacturers and health care providers on medicine uses, indications and clinical and economic outcomes;

BE IT FURTHER RESOLVED, that drug manufacturers and insurers should be encouraged to explore and test value-based contracting in pilot programs to study effectiveness and operational feasibility of these models; and

BE IT FINALLY RESOLVED, that a copy of this resolution be transmitted to the President of the United States, the Vice- President of the United States, members of the U.S. Congress, and other federal and state officials as appropriate.

• SPONSOR: Senator Donne Trotter (IL)
• Committee of Jurisdiction: Health and Human Services Policy Committee
• Certified by Committee Chair(s): Representative John Richard C. King (SC) and Representative Toni Rose (TX)
• Ratified in Plenary Session: Ratification Date is December 2, 2017
• Ratification is certified by: Representative Gregory W. Porter (IN), President

A RESOLUTION ON IMPROVING PATIENT AFFORDABILITY OF MEDICINES

WHEREAS, medicines are a great investment in improving patient health and reducing overall cost to the broader health care system;

WHEREAS, new medicines provided 73 percent of the total increase in life expectancy between 2000 and 2009, and every additional dollar spent on medicines for adherent patients with congestive heart failure, high blood pressure, diabetes and high cholesterol generates $3 to $10 dollars in savings on emergency room visits and inpatient hospitalizations;

WHEREAS, spending on prescription medicines accounted for just 10 percent of overall health care spending in the United States;

WHEREAS, a patient’s health insurance coverage can control his or her access to medicines through requirements such as prior authorization, step therapy or fail first, quantity limits, formulary exclusions and dose limits;

WHEREAS, a patient’s health insurance coverage determines what he or she pays “out-of-pocket” at the pharmacy counter for the medicines they need;

WHEREAS, a patient’s out-of-pocket cost for a medicine has a direct impact on adherence to prescription drug treatment, and a patient may choose to not start or to discontinue therapy if the out-of-pocket cost is high, which can have a direct impact on a patient’s health and may result in more downstream costs to the health care system;

WHEREAS, when health plans use co-pays, patients pay a predictable price for medicines, but as more health plans utilize prescription drug deductibles and co-insurance, patients are exposed to higher costs early in the plan year and receive no benefit from their insurance plan to help reduce these costs;

WHEREAS, in some areas a patient may have no choice but to enroll in a plan with a high deductible and co-insurance for medicines; and

WHEREAS, while drug manufacturers provide health plans and pharmacy benefit managers (PBMs) with discounts and rebates to lower the price the health plans and PBMs pay for medicines, in some cases patients may still be forced to pay the full price for the drug before meeting their deductible or when paying coinsurance.

THEREFORE BE IT RESOLVED, that the National Black Caucus of State Legislators (NBCSL) recognizes that prescription medicines are a critical tool in preventing, treating and curing disease;

BE IT FURTHER RESOLVED, that patients should have insurance options that allow them to choose between different benefit designs for medicines, including options with fixed copays and no deductibles, and some of the savings negotiated by manufacturers and health plans and PBMs should benefit patients; and

BE IT FINALLY RESOLVED, that the NBCSL send a copy of this resolution to the President of the United States, the Vice President of the United States, members of Congress, and other federal and state government officials as appropriate.

• SPONSOR: Senator Donne Trotter (IL)
• Committee of Jurisdiction: Health and Human Services Policy Committee
• Certified by Committee Chair: Representative John Richard C. King (SC) and Representative Toni Rose (TX)
• Ratified in Plenary Session: Ratification Date is December 2, 2017
• Ratification is certified by: Representative Gregory W. Porter (IN), President

A RESOLUTION ON ENHANCING COMPETITION IN THE GENERIC MARKET

WHEREAS, medicines are among the most powerful tools used to treat, cure, and prevent illness, and are one of the medical interventions that decrease in cost over time;

WHEREAS, after a limited time of patent protection, innovator medicines become generic medicines, which provide the same clinical benefits at substantial cost savings;

WHEREAS, a 2016 U.S. Government Accountability Office (GAO) report found that, among all generic drugs paid for by the Medicare Part D program, prices fell 59 percent from 2010 to 2015;

WHEREAS, the price of generic medicines that entered the market between 2011 and 2013 fell 79 percent within 12 months compared to only 44 percent for generics that entered the market between 2002 and 2004;

WHEREAS, in the 2016 GAO report found that of the generic drugs that were on the market for the entire five year time period analyzed, 22 percent had at least one price increase of 100 percent or more; however, the report noted that these increases “still may not result in a very high price because the beginning price was relatively low”;

WHEREAS, in 2016 the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE) issued a brief on generic drug trends, that stated “overall generic drug prices are decreasing even if trends for specific drugs may differ”;

WHEREAS, ASPE noted that “spikes” in generic drug prices “apply to relatively small segments of the market”; and

WHEREAS, generic drug price spikes can be attributed to “small markets with limited entry; the impact of mergers, acquisitions, and market exits; the ability to obtain new market exclusivities; and distribution activities.”

THEREFORE, BE IT RESOLVED, that the National Black Caucus of State Legislators (NBCSL) recognizes that competition in the generics market drives prices down, and when there is little or no competition, an environment for higher generic drug prices can potentially be created;

BE IT FURTHER RESOLVED, that to improve the affordability of medicines, market factors that enable generic drug price spikes must be corrected, including FDA increasing the number and speed of generic approvals, giving priority review to Abbreviated New Drug Applications (ANDAs) for medicines with limited competition, and making information available regarding which generic medicines have limited or no competition in the marketplace; and

BE IT FINALLY RESOLVED, that the NBCSL send a copy of this resolution to the President of the United States, the Vice President of the United States, members of Congress, and other federal and state government officials as appropriate.

• SPONSOR: Senator Donne Trotter (IL)
• Committee of Jurisdiction: Health and Human Services Policy Committee
• Certified by Committee Chair(s): Representative John Richard C. King (SC) and Representative Toni Rose (TX)
• Ratified in Plenary Session: Ratification Date is December 2, 2017
• Ratification is certified by: Representative Gregory W. Porter (IN), President

A RESOLUTION CALLING ON FUNDING FOR RESEARCH, TRAINING, AND INCENTIVES FOR THE ESTABLISHMENT OF A SICKLE CELL REGISTRY

WHEREAS, the National Black Caucus of State Legislators (NBCSL) supports initiatives designed to address health care disparities and inequalities that occur throughout communities served by NBCSL legislators;

WHEREAS, the mission of the NBCSL is to develop, conduct, and promote educational, research, and training programs designed to enhance the effectiveness of its members;

WHEREAS, according to the Centers for Disease Control and Prevention (CDC), sickle cell disease (SCD) affects 100,000 Americans and occurs in 1 of every 365 Black or African American birth and about 1 in 13 Black or African American babies is born with sickle cell trait (SCT);

WHEREAS, in 2010, the CDC and the National Heart, Lung, and Blood Institute began a two year effort to collect data on individuals with SCD and thalassemia in the states of California, Florida, Georgia, Michigan, New York, North Carolina, and Pennsylvania, as part of the Sickle Cell Surveillance and Registry Program (SCSR Program), to report on the data collected, and to launch related health prevention and promotion activities;

WHEREAS, the SCSR Program found that the total healthcare costs associated with SCD were more than one billion dollars annually, the total hospital costs for hospitalizations principally for SCD were approximately 488 million dollars, and among those hospital stays, approximately 66 percent were paid by Medicaid and 13 percent were paid by Medicare;

WHEREAS, the SCSR Program also found that current challenges include the unknown prevalence of SCD, a lack of access to specialty and quality care, especially for adults and including management or acute painful episodes, a lack of understanding of risk factors and complications over the lifespan, an absence of a national coordination of services, and a lack of community awareness;

WHEREAS, health care professionals specializing in the treatment of patients with SCD or conducting research relating to SCD or SCT are not compensated as highly as their peers specializing in other areas of medicine, which undermines the retention of qualified health care professionals willing to provide these services;

WHEREAS, medical and nursing schools and licensing boards do not require sufficient education or training about the symptoms, treatment, and management of SCD;

WHEREAS, legislation to establish new federal sickle cell disease research, surveillance, prevention, and treatment programs, including through the award of grants to collect data on the prevalence and demographics of SCD and SCT has been introduced in Congress;

WHEREAS, sickle cell patient registries would facilitate the collection of data nationwide about the incidence and nature of SCD and SCT, which could be used to educate primary, specialty, and emergency care physicians and other health care practitioners, inform policy discussions, and raise public awareness;

WHEREAS, a sickle cell patient registry through which a physician may register patients with SCD or SCT could help coordinate and improve access to care, especially for patients who seek acute care, and improve the services provided to help patients manage symptoms;

WHEREAS, improved access to care should include access to effective management of painful acute episodes, including through the prescription of appropriate medication as determined by the treating physician;

WHEREAS, SCD and SCT education and training requirements for physicians, nurses and other healthcare professionals would improve access to quality care; and

WHEREAS, loan forgiveness programs and other financial incentives targeting health care professionals who choose to specialize in diagnosing and treating patients with SCD or SCT would promote the quality of care provided to these patients.

THEREFORE BE IT RESOLVED, that the National Black Caucus of State Legislators (NBCSL) recognizes that sickle cell disease (SCD) and sickle cell trait (SCT) significantly impact the communities served by NBCSL legislators, there is a need to collect and analyze data on the prevalence of SCD and SCT throughout the nation, and use of voluntary sickle cell registries can be an effective tool to promote data collection and analysis;

BE IT FURTHER RESOLVED, that the NBCSL urges state legislatures and departments of health to take the steps necessary to create and maintain a voluntary sickle cell patient registry to collect and study data on the incidence and nature of SCD and SCT to improve patient care and access to services;

BE IT FURTHER RESOLVED, that the NBCSL urges state legislatures and departments of health in jurisdictions that allow the use of cannabis for medical purposes to include acute painful episodes of SCD as a qualifying condition authorizing the patient to use cannabis to control the pain, and to encourage state legislatures in states not yet allowing the use of cannabis for medical purposes to legalize the practice;

BE IT FURTHER RESOVLED, that the NBCSL urges medical providers to engage in training and knowledge on bias as it relates to pain management in the face of the opioid crisis;

BE IT FURTHER RESOLVED, that the NBCSL urges state legislatures, medical and nursing schools, and health care licensing boards to require training and education in SCD symptoms, diagnosis, treatment, and management, especially for adult patients;

BE IT FURTHER RESOLVED, that the NBCSL urges state legislatures and medical and nursing schools to consider loan forgiveness programs and other financial incentives to increase the number of health care practitioners who are appropriately qualified to diagnose and treat SCD and to retain those health care professionals; and

BE IT FINALLY RESOLVED, that the NBCSL send a copy of this resolution to the President of the United States, the Vice President of the United States, members of Congress, and other federal and state government officials as appropriate.

• SPONSOR: Representative John Richard C. King (SC)
• Committee of Jurisdiction: Health and Human Services Policy Committee
• Certified by Committee Chair(s): Representative John Richard C. King (SC) and Representative Toni Rose (TX)
• Ratified in Plenary Session: Ratification Date is December 2, 2017
• Ratification is certified by: Representative Gregory W. Porter (IN), President

A RESOLUTION URGING STATES TO IMPROVE ACCESS TO VOLUNTARY SCREENING FOR HIV AND STIS

WHEREAS, the Centers for Disease Control and Prevention (CDC) estimates that 20,000,000 new sexually transmitted infections (STIS) occur each year in the United States and that over 1,200,000 people in the United States are living with HIV;

WHEREAS, many common long-term and initially asymptomatic STIs remain undiagnosed, or diagnosed at later stages, leading to increased rates of mortality, morbidity, disability, and transmission;

WHEREAS, 166,000 people living in the United States are unaware of their HIV status and 30 percent of new HIV infections are transmitted by people are living with undiagnosed HIV;

WHEREAS, although African-Americans account for about 13 percent of the United States population, they account for nearly half of all HIV/AIDS cases and other STIs and have a higher incidence of mortality and morbidity for HIV/AIDS and most STIs;

WHEREAS, African American women who have sex with men account for the majority of the HIV/AIDS infections among all women;

WHEREAS, a lack of insurance, limited time, cost and resources in medical settings, stigma and lack of accurate information among communities and providers contribute to inadequate screening for HIV/AIDS and other STIs;

WHEREAS, health equity and disparities remain a significant public health challenge with the burden of HIV/ AIDS and other STIs falling disproportionately on certain populations;

WHEREAS, there is a need for better education and training among health care providers on the incidence of HIV/AIDS and other STIs in the communities they serve and on the most effective ways to promote routine screening for patients with HIV/AIDS and other STIs and then to treat those patients; and

WHEREAS, there is a need for increased awareness of accurate and up-to-date information among health care providers and the public to ensure access to and utilization of quality health care services that promote early detection and treatment of HIV/AIDS and other STIs and that prevent these diseases.

THEREFORE BE IT RESOLVED, that the National Black Caucus of State Legislators (NBCSL) recognizes that HIV/AIDS and other STIs significantly and disproportionately impact the communities served by NBCSL legislators and that increased access to, and quality and affordability of, voluntary and medically appropriate screening is critical to protecting the health of these communities;

BE IT FURTHER RESOLVED, that the NBCSL urges state legislatures and departments of health to take the steps necessary to improve access to, and quality and affordability of, routine screenings for HIV/AIDS and other STIs by all communities, as well as to use of all screening and treatment services by all communities;

BE IT FURTHER RESOLVED, that the NBCSL urges state legislatures and departments of health to facilitate the collection and analysis of data pertaining to access to, and quality and affordability of, routine screenings for HIV/AIDS and other STIs, as well as utilization of available screening and treatment services for HIV/AIDS and other STIs by all communities;

BE IT FURTHER RESOLVED, that the NBCSL urges state legislatures, medical and nursing schools, and health care licensing boards to require training and education on the importance of offering screenings for HIV/AIDS and other STIs as a routine part of health care;

BE IT FURTHER RESOLVED, that the NBCSL urges Congress and the Administration   address the health care disparities and inequalities related to the early detection, prevention, and treatment of HIV/AIDS and other STIs in certain communities; and

BE IT FINALLY RESOLVED, that the NBCSL send a copy of this resolution to the President of the United States, the Vice President of the United States, members of Congress, and other federal and state government officials as appropriate.

• SPONSOR: Representative John Richard C. King (SC)
• Committee of Jurisdiction: Health and Human Services Policy Committee
• Certified by Committee Chair(s): Representative John Richard C. King (SC) and Representative Toni Rose (TX)
• Ratified in Plenary Session: Ratification Date is December 2, 2017
• Ratification is certified by: Representative Gregory W. Porter (IN), President