Praise for New Hampshire's Prescription Drug Affordability Board • New Hampshire Bulletin

My daughter's annual pharmacy bill is routinely several times more than my salary as a government employee whose family relies on the health benefits that come with my job. This grim fact is always at the forefront of my mind, but especially now as I read a remarkable document: the latest Annual report of New Hampshire Committee on Prescription Drug Affordability (PDAB).

Cystic fibrosis — a genetic, chronic disease that slowly destroys the lungs and other organs — is the reason my 23-year-old child takes the prescription drug Trikafta. This groundbreaking drug is the main reason most people with cystic fibrosis can now expect to live well into adulthood and beyond.

Unfortunately, according to PDAB's annual report, Trikafta is also the most expensive drug in New Hampshire – or at least the most expensive among the drugs included in health plans for state employees and retirees. The average total cost is $260,413 per year.

What makes the PDAB annual report noteworthy, however, is not just that it provides such facts as an example of how the inflated costs of cutting-edge prescription drugs are driving health care costs to unsustainable levels. The PDAB report then explains in blunt and unambiguous terms exactly what the problem is.

“Unlike all other industrialized and wealthy countries, the United States allows pharmaceutical manufacturers to set launch prices and increase list prices at will,” the report said. “These exorbitant costs … place upward pressure on premiums for all beneficiaries as health plans and employers struggle to balance demand for these treatments and all other health services.”

Maybe you've never heard of Trikafta. But there are also names on the list of the most expensive prescription drugs in New Hampshire that are better known: blockbuster weight-loss drugs like Ozempic and Wegovy, the blood thinner Eliquis and Humira, which treats arthritis. Overall, Humira represents the largest bill of all (about $22 million for the public employee health plans covered in the report).

New Hampshire is one of 11 states with a PDAB, and the latest annual report shows why we are fortunate to have such a body. The pretext for creating such a board is the need to help the state save on costs of insuring its employees, but educating the board on the costs we all incur as consumers of health care and health insurance is of great value.

Not all PDABs are the same. Unlike ours, the Colorado PDAB has explicit authority to set a “price cap” on very expensive prescription drugs. Trikafta happened to be the first drug considered for such an effect, with disturbing results.

Because of intense lobbying by patient groups and CF caregivers who succumbed to the pharmaceutical industry's propaganda (and financial help), the Colorado PDAB actually declared Trikafta “affordable” a year ago, even though the price was similar to the one just publicly reported in New Hampshire . This struck a chord with me, in part because my daughter was vilified by others in the CF community for testifying before the Colorado PDAB. She made her father proud by arguing that no drug with a price of this magnitude could be considered affordable. Keep in mind that many prescription drug plans come with 20 percent copays—which means $52,000 a year out of pocket for a $260,000 drug.

Although New Hampshire's PDAB statute does not authorize the board to set price caps, there is tremendous value in having a government agency describe this crisis so directly and matter-of-factly. The PDAB report states that “the pharmaceutical market is notoriously opaque,” ​​which is quite an understatement. What makes the report so powerful is the comprehensive disclosure of drug pricing data that the industry typically keeps secret.

So it shouldn't surprise anyone that the pharmaceutical industry is constantly trying to kill the PDAB, which is actually still in the pipeline after four years of tight budgets. Our thanks go to the board's new executive director, Kirk Williamson, as lead author of the report. So does PDAB Chairman, Claremont Democratic Rep. Gary Merchant, a retired pharmacist who knows how important this work is.

In just three years—perhaps sooner if the Affordable Care Act takes effect, as some fear—my daughter will be 26 and no longer covered by her father's employee health insurance plan. But even if she could stick to my plan forever, and even though my daughter means a lot to me, I can't just expect my tax colleagues and premium payers to cover drug costs of this magnitude.

That's why I'm so grateful to our Prescription Drug Affordability Board and encourage my fellow citizens to read its latest annual report.