Waiting a month for his insurance company to approve his insulin medication, Timothy Dontigney could not afford to pay for the medication upfront and had to go for a time without it, a dangerous position for someone with diabetes.
The Middletown senior resident living on a fixed income worried about his insulin levels getting out of control, leading to serious health consequences.
“I watched what I ate very carefully,” he said. “I drank a lot of water to flush my system out and made sure my sugar would stay low.”
This is not the first time Dontigney has been forced to lobby for his insurance company to cover his medications, describing it as a constant battle.
But he remains hopeful after Gov. Ned Lamont recently signed what lawmakers referred to as the ‘strongest prescription drug legislation in the country,’ providing transparency and lowering costs.
David Flaherty, pharmacy manager at Arrow Pharmacy where the legislation was signed on July 30, said a lot of the time insurance companies won’t cover drugs because of the prices.
The legislation includes putting a price cap on generic drugs, negotiating bulk prices resulting in lower costs, exploring the idea of the state making its own GLP-1 drugs for weight loss, and seeking federal approval to import prescription drugs from Canada, among other initiatives.
“If there is a capacity to get less expensive drugs from Canada, we would be absolutely in favor of that as long as we can assure that they are as effective and safe as the current drugs that we have,” said Flaherty.
Sen Matt Lesser, D-Middletown, co-chair of the Human Services Committee, who sponsored the legislation along with other members of the Bipartisan Drug Task Force including Rep. Jillian Gilchrest, D-West Hartford, Sen. Jeff Gordon, R-Woodstock and Rep. Tracy Marra, R-Darien, said drug prices are simply not sustainable.
“We are paying the highest drug prices in the world. Americans can’t continue to afford it,” he said. “They are looking for answers from leaders of all political stripes and it is our job to deliver on that. At a time when Medicaid is getting cut nationally, any money spent on prescription drugs is money we are not spending on caring for the most vulnerable in our state.”
Fair dealing
The new law beginning in October also requires pharmacy benefits managers “to exercise good faith and fair dealing in performing their contractual duties to health carriers or other health benefit plan sponsors,” according to the bill’s analysis.
Further, the new law also requires that a PBM “must notify the health carrier or plan sponsor, in writing if any of the PBM’s activities, policies or practices directly or indirectly present a conflict of interest,” the analysis also stated.
Beginning in January the law requires a PBM to “offer a health plan the option of being charged the same price for a prescription drug that the PBM pays a pharmacy for the drug,” the analysis further states.
Lamont said at the bill signing ceremony that the cost of prescription drugs used to be 10% of health care spending.
“Today it is 20%,” he said. “There is a real imbalance out there between the PBM’s and the big guys and the independent pharmacists and each one of you, the consumers. We are trying to get a little more power behind this negotiation.”
The governor said group purchasing could save people between 18 and 80% on some drug costs.
“I am working with other governments to see what we can do as a group with group purchasing going forward,” he said.
Soaring costs
The state Office of Health Strategy’s most recent cost growth benchmark found that prescription drug costs are the “fastest rising cost in health care, rising 9.3% from 2022 to 2023.
“Taxpayers have been seeing double digit increases on the cost of prescription drugs in the Medicaid program,” said Lesser. “The taxpayer is on the hook.”
Lesser said the largest single growth area in the last year was for GLP-1 weight loss drugs, where total state spending exceeds $150 million.
“That’s why we are looking at getting federal approval to declare them generic and make our own with a licensed pharmaceutical company partner,” he said.
Nicole Rall, spokesman for the Connecticut Hospital Association, said in an email Monday that “hospitals across Connecticut continue to face unsustainable increases in the cost of prescription drugs – an issue that impacts the financial stability of hospitals as well as affordability and access for patients.
“The latest Kaufman Hall analysis of Connecticut hospitals found that the median increase in drug expenses was 10% between FY 2022 and FY 2023—amounting to a $249 million increase,” she said. “This increase exceeds both the Northeast/Mid-Atlantic and national medians. Rising prescription drug costs are just one of many mounting financial pressures that hospitals must navigate. These escalating trends are not new, and Connecticut hospitals remain committed to working collaboratively with lawmakers, advocates, and state leaders to address them.”
Rall said hospitals are looking forward to participating in the newly established Advisory Council on Pharmaceutical Procurement and the Task Force to Study Emergency Preparedness and Mitigation Strategies for Prescription Drug Shortages.”
The council was established as part of the legislation.
Bipartisan task force
Lesser said he had been working on drug reform issues for the last few years, recognizing that drug costs were one of the fastest growing areas of health care spending.
He reached out to Gordon this past fall gauging his interest in creating a task force on the issue of affordability of prescription drug costs.
He then brought in the other members including Marra and Gilchrest. The task force formed in November 2024 and included doctors, nurses, pharmacists, experts from the pharmaceutical industry, and advocates and patients.
From there, legislation was then drafted.
“This is a bill that I am proud to say puts people over profits when we are talking about trying to help hardworking people, their families and seniors and businesses that are dealing with the rising cost of prescriptions,” said Gordon at the recent bill signing ceremony.
Gilchrest said through the taskforce legislators also learned about the negative impact of the high cost of prescription drugs on people’s health.
“There are a lot of people across the state who can’t afford their prescription drugs so they take half or they go a few days without taking it,” she said. “We don’t want that to happen in our state.”
Marra said in a statement that while lowering costs is important, the new law “also provides strong support for pharmacies.
“When we support our pharmacies, we’re supporting the communities they serve, and a pharmacist’s reach goes well beyond basic, over-the-counter and prescription medications and now includes important consultations on health care,” she said. “Health care needs to be accessible to be effective, and pharmacies and pharmacists are the most accessible health care we have. It’s important we support them.”