The truth about Nebraska's price setting push

As Nebraska lawmakers consider consider Legislative Bill 833, a proposal to create a so-called “prescription drug affordability board,” it’s important to know the truth about how government price setting will affect Nebraskans. A price-setting board could limit access to critical medicines while inserting the government between patients and doctors.

A recent poll found that 83% of adults in Nebraska agree that elected officials should ensure health insurance companies and pharmacy benefit managers (PBMs) are held accountable for their role in keeping patients from the medicines they need.

MYTH: A PDAB will help Nebraskans.

FACT: A Nebraska PDAB would stand between patients and doctors and decide which medicines are “worth” covering. This legislation would allow an unelected board to set an upper payment limit (UPL) – or price cap on all purchases and payer reimbursements of medicine dispensed or administered to individuals in the state. Regulating drug prices could lead to a shortage of or limit access to medicines for patients. Research shows that “[i]t is simply not true that government can impose significant price controls without damaging the chances for future cures.”

To date, there has been no real-world evidence to show that an upper payment limit actually benefits patients at the pharmacy counter. This legislation could leave hospitals, pharmacies, infusion clinics, and other health care providers with substantial costs that could impact patient access to needed treatments.

MYTH: A PDAB would finally address health concerns in Nebraska.

FACT: The current PDAB proposal fails to address the root problems patients face —health insurance companies and their PBM middlemen, who decide how much patients must pay at the pharmacy counter and are making it increasingly more difficult for patients to get the medicines they need. It doesn’t account for rising copays, deductibles, and coinsurance.

MYTH: A PDAB would save Nebraskans money.

FACT: Nebraska would have to foot the bill for an expensive PDAB if passed. Maryland has spent millions of dollars on its PDAB since 2019 with no evidence of lowering patient costs. PDABs also fail to address the real reason for rising costs: health insurance companies and PBMs.

MYTH: Biopharmaceutical manufacturers are needlessly pointing fingers at health insurers and PBM middlemen.

FACT: Manufacturers offer rebates and steep discounts that PBMs are not always passing to patients directly. Manufacturers also offer patient assistance for patients without insurance or to close the gap where insurers fail. It’s PBMs that decide what medicines patients can get and what people pay out-of-pocket, and in some cases, patients are paying the undiscounted price while the insurer and their PBM keep the savings.

MYTH: A PDAB and strong research and development in Nebraska can exist at the same time.

FACT: Government price controls, as the industry continues to be tirelessly dedicated to finding treatments and cures, divert resources elsewhere and could have chilling effects on research and development of new medicines.

MYTH: Nebraska legislators have identified a way to track and ensure savings for consumer out-of-pocket costs.

FACT: Lawmakers have yet to articulate how they will monitor and verify alleged savings for consumer out-of-pocket costs reported by plans. Many questions remain unanswered, and Nebraskans may need to brace themselves for following in the footsteps of Colorado and Maryland who have spent millions of dollars without saving patients a dime.

For more information on the harmful consequences of legislation like LB 833 and policies state lawmakers can pursue to lower costs and increase access, visit phrma.org/states.