Drug prices are hard to find. A newly enacted law in Colorado aims to make that information more readily available to doctors within the state.
Signed by Governor Jared Polis in May and made effective this August, House Bill 19-1131 mandates pharmaceutical company representatives provide prescribers with the sticker prices of the drugs they're marketing.
In that regard, the bill is relatively unique, as most state efforts around pricing transparency have sought to require drugmakers relay cost information to the state or health plans, rather than specifically to doctors.
Colorado's law is part of a broader push, however, to increase visibility into the prices drugmakers set for their products.
This year alone 51 bills dealing with drug cost transparency were introduced in state legislatures, five of which were signed into law in addition to Colorado's, according to the National Academy for State Health Policy. States passing price transparency legislation include Maine, New Hampshire, Oregon, Texas and Washington.
"A lot of states start with transparency, and see transparency as a foundational step before moving on to other policy or regulatory efforts building off what they learn," said Jennifer Reck, a project director at NASHP, in an interview.
Colorado's law is still in the process of being implemented, said Sonya Jaquez Lewis, the Colorado state representative who drafted the bill, in an email to BioPharma Dive.
Already, though, some drugmakers have made the information required under HB 19-1131 available online. Sanofi and Astellas, a Japansese drugmaker, have posted pages with links to the list prices of all their products, mimicking information provided to doctors in Vermont under a law there. Forms from other drugmakers detailing pricing information and generic competitors can also be readily found.
Along with list prices, companies marketing in Colorado are also required to provide the names of three generic treatments within the same therapeutic class, a provision designed to share with doctors potentially cheaper options.
One for Merck & Co.'s HIV medicine Pifeltro (doravirine), for example, lists as alternative treatments efavirenz and nevirapine.
Per the law, the information must be conveyed when a company representative engages in "prescription drug marketing," a broad term that includes in-person meetings, emails, telephone or video conferences. Not included, however, are conversations at scientific conferences.
Whether or not knowing the potential cost of a patient's treatment will alter doctor's prescribing, though, isn't quite clear.
One study, published in the American Economic Journal last February, found that physicians are perceptive of affordability issues and will adjust prescribing. Researchers concluded, however, that such a shift would be most likely to occur following the nationwide entry of a well-known generic, such as that of the statin Zocor (simvastatin).
List prices only tell part of the story, of course, as rebates and discounts provided by manufacturers to insurers can mean the list price of a drug is quite different from the net price.
That's an argument that pharma companies used to push back against a Trump administration regulation mandating drugmakers disclose list prices in television advertising to consumers. While a court struck down that rule in July, companies have begun to direct consumers to cost information provided online, usually alongside offers of co-pay assistance or other payment aids.
A lack of federal legislation has been one motivator for states to take action on their own.
"We'll continue to see states try to address this issue, particularly while federal efforts are more up in the air," said Serra Schlanger, an associate at the Washington, D.C.-based law firm Hyman, Phelps & McNamara, in an interview.
That may be changing, however, as both the Senate and the House of Representatives advance large drug pricing packages. A plan by the Trump administration to tie Medicare reimbursement to prices paid abroad is under review at the Office of Management and Budget as well.
Federal-level legislation also appears necessary to force changes to actual prices, rather than just pulling back the curtain on what products cost.
"It's harder for states to try to mandate specific changes to pricing," said Schlanger. "For example, a Maryland law proposing to prohibit price gouging was struck down last year."