Nevada lawmakers are on the verge of passing a bill that's meant to help patients, but that would make it impossible for them to obtain certain medicines. Nevadans' health, and even their lives, depend on Gov. Joe Lombardo vetoing this well-intentioned but poorly designed bill.
Lawmakers' goal is admirable. Starting next year, the federal government will begin capping drug prices in Medicare. With Assembly Bill 259, state legislators are trying to give the rest of Nevadans -- the 83% of state residents who aren't Medicare beneficiaries -- access to those same lower prices.
But as with many legislative endeavors, the devil is in the details.
The bill does not and in fact, cannot directly lower what patients pay at the pharmacy counter. State lawmakers don't have the power to dictate the specific out-of-pocket charges set by insurers.
The legislation simply caps what insurers and hospitals can pay pharmacies for certain medicines. But there's no guarantee that pharmacies would be able to purchase those medicines at the Medicare prices. In fact, for a variety of complex contractual reasons, they almost certainly wouldn't.
As a result, pharmacies would be forced to purchase many drugs at prevailing national commercial prices -- but would only be reimbursed in Nevada at artificially low, capped prices. In other words, they would take a loss every time they fill one of these prescriptions.
Pharmacies would simply no longer stock many of the drugs in question. This would be detrimental for individuals with rare chronic conditions, like inheritable bleeding disorders. Medications to treat bleeding disorders are often some of the most expensive. Pharmacies could easily choose to stop carrying these life-extending medications, putting many Nevadans at risk, especially those who live in rural parts of the state.
This isn't a hypothetical threat. Nearly 33% of independent pharmacies have already decided not to stock at least one of the 10 medicines that'll be subject to Medicare price controls nationwide next year, according to a recent survey from the National Community Pharmacists Association. And many more pharmacists are considering following suit -- because complicated reimbursement dynamics would likely force them to sell the medicines at a loss.
Assembly Bill 259 would greatly exacerbate this already concerning problem. Pharmacies, especially independent community pharmacies, could be forced to stop carrying drugs that are essential for managing diabetes, bleeding disorders, cancer and other serious conditions. Patients would face empty shelves. Access to regular treatment is essential for individuals with inherited bleeding disorders and others with rare and chronic conditions. It would be irresponsible to put patients at risk of missing treatment.
Rather than jeopardizing access to medicines, lawmakers could focus on reforms that would meaningfully lower patients' pharmacy bills. Perhaps the most promising would require pharmacy benefit managers and insurers to pass along the rebates they negotiate to patients, in the form of lower copays and coinsurance. These changes would directly lower the amount patients pay, without threatening the supply of essential medicines.
Lawmakers deserve credit for trying to make prescriptions more affordable. But AB 259 is not the way to do it. It risks creating shortages and ultimately harming the very people it aims to help.
Lombardo vetoed a nearly identical bill two years ago. He was right to do so then, and if AB 259 reaches his desk, he should do so again. Nevadans' lives depend on it.
Jacob Murdock is executive director of the Nevada chapter of the National Bleeding Disorders Foundation, an adjunct professor at UNLV in the College of Continuing Education, and a resident of Las Vegas.