Oregon lawmakers to address increasing prescription-drug costs

HEALTH ROUNDUP: Bills in Oregon Legislature to provide relief for families burdened by skyrocketing drug costs; Oregon hospitals overbill Medicare.

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The Oregon Legislature is considering three bills that would provide relief for families burdened by skyrocketing drug costs

Spending on prescription drugs rose 13.1 percent in 2014, the Statesman Journal reports.

As a response to concerns from constituents, the health care committee is considering bills that would allow citizens to procure lower cost life-saving medications.

One would allow replacing biologics with “biosimilar products.” The SJ story notes that some patients are wary of this bill because of how they could react to a different drug than what they were prescribed.

The next bill would cap copay at $100 for a 30-day supply.

SJ writes:

The copay cap would help patients with complex and hard-to-treat diseases stay financially afloat, but insurance companies argued it would do nothing to solve the underlying problem of drug companies’ jacking up prices. Payers liked the idea of requiring manufacturers of high-cost drugs to be transparent about their prices, but those in the industry said they would stop selling their products in Oregon if such a bill became law.

The third bill would require pharmaceutical manufacturers to report the cost of creating a drug priced at $10,000 or higher.

Jesse O’Brien, health care advocate with OSPIRG, testified in favor of requiring high-cost drug manufacturers to disclose pricing information, saying the Oregon Insurance Division’s public rate review process has saved Oregonians more than $179 million in health insurance premium costs in 2010. Claxton said that for drugs that don’t have competition, the only way to bring down costs is to regulate them.

A change to drug pricing should not be expected in this legislative session.

Oregon hospitals overbill Medicare

Analysis by an advocacy group found that Medicare lost $46 billion to overbilling in 2014.

According to the Medicare Trust Fund, Oregon ranks 39th in waste, Portland Business Journal reports.

Much of the overbilling occurs due to bookkeeping and billing mistakes, Walter said. Procedures are billed incorrectly, or are mistakenly billed to Medicare multiple times. Medicare fraud also occurs, but less frequently.

That’s mainly what happened with Oregon Health & Science University between 2010 and 2012, during which the hospital ran up more than $2.4 million in Medicare overbillings from 57 incorrectly billed inpatient claims, according to an October 2014 review by the Department of Health and Human Services. More than three-quarters of the OHSU overbillings occurred due to a paperwork mix-up over bone marrow and stem cell transplants, says the report from the HHS Office of Inspector General. OHSU staff billed the procedures as inpatient care when they should have been billed as outpatient care.

OHSU refunded the $2.4 million, PBJ reports.



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