Ensure access

Share rebate savings with patients

More than 1.8 million Arkansans are living with at least one chronic disease, and more than 600,000 are living with mental illness. Patients throughout the state struggle with accessing and affording the treatment they need.

For chronic-disease patients — and in particular those with mental illness — medications are not optional. They are necessary to keep them healthy, working in the community, caring for their family, and productive members of society.

Thankfully, this year the state Legislature has the opportunity to help these neighbors and countless others living with chronic conditions by increasing their access to — and affordability of — critical treatments and therapies.

House Bill 1481 would provide relief to Arkansans, improving affordability of prescription medications by requiring pharmacy benefit managers (PBMs) to pass negotiated rebates through to patients at the point of sale. This legislation has broad support from over 20 local and national patient advocate communities.

Rep. Brandon Achor and Sen. Justin Boyd should be applauded for their bold leadership in fixing our broken health care system, and I encourage other members to follow suit by offering their support.

The cost of medications to patients is often much higher than the price paid by their insurance company — for the same medicine on the same prescription. That’s because PBMs and the health insurance companies they represent negotiate significant rebates on the cost of prescription medications and do not share these savings with patients. The average rebate on a branded drug is nearly 50%, forcing insured Arkansans to pay nearly twice what they should for what they need to live.

The excess amount paid by patients is going to the PBMs and insurance companies, many of which are vertically integrated. The top three PBMs control 75% to 80% of the U.S. drug market and are driving up the list prices of drugs by demanding rebates in exchange for formulary placement.

Insurance companies falsely point out that they use these rebates to keep premiums down but the statistical impact of passing through these rebates to the patient would result in a less than 1% premium increase for plan participants. Not to mention that the current rebate practice is reverse insurance, demanding that the sick subsidize the healthy.

Rural communities, in particular, are disparately impacted by chronic conditions and also exhibit low rates of employer-sponsored insurance, driving them to the marketplace for coverage. If passed, this legislation would significantly improve out-ofpocket costs for Arkansans on state exchange plans, protecting patients’ pockets and improving affordability in our most vulnerable communities.

It has become abundantly clear that this issue is being recognized nationwide. Landmark rebate pass-through legislation was passed in 2021 in West Virginia and was proposed in 15 states in 2022. It is also on the Council of State Government’s Suggested State Legislation list and currently pending in four other states this year. We expect more concerned legislatures across the country to consider adding this protection for their fully insured citizens.

By helping patients live healthier lives now, we also help them stay healthy in the future. By decreasing barriers to treatment access, we are simultaneously helping curb the often-devastating effects of chronic illness and lowering the cost of comorbidities, which effectively saves patients — and the state — money.

On behalf of Arkansans living with mental illness and other chronic conditions, and in alliance with fellow leading patient advocacy groups, I call on Arkansas legislators to vote yes on HB1481 and share the savings with patients to ensure a healthier Arkansas for generations to come.