N.D. Senate committee hears proposals to lower prescription drug costs

By Brayden Zenker

N.D. Newspaper Association Education Foundation

BISMARCK – The Senate Human Services Committee heard testimony on three bills aimed at getting North Dakota consumers access to lower prescription prices.

“Most of us have never heard a good explanation of why the same drug a few miles across the border [in Canada] sells for 40%, 30% or sometimes even 20% of the price we pay in this country,” said Sen. Howard Anderson Jr., R-Turtle Lake (District 8), who introduced all three.

The first of the three, SB 2170, would create a system to set payment rates for prescription drugs based on international prices, specifically the price of those drugs in Canada. The bill would compare prescription drug prices in America to prices in Alberta, British Columbia, Ontario and Quebec. After comparison, the lowest price would be used as reference rate, or maximum rate, for consumers. 

“This is an issue that has continued to grow in the minds of our members,” said Josh Askvig, state director of AARP. “For the last five years, I have not gone to an event where somebody hasn’t asked me about prescription drug costs.”

According to Askvig, the bill “allows states to ‘import’ the drugs’ prices instead of the actual drugs.” According to the National Academy for State Health Policy, the average savings on prescription drug costs would be around 75%.

In North Dakota the average costs of prescription drugs increased by 57.8% from 2012-2017. In 2017, according to the State Health Access Data Assistance Center, 31% of North Dakota residents stopped taking prescription drugs because of cost.  

Michael and Marilyn Worner, Fargo residents and retired educators, spoke in favor of SB 2170. 

“This year my wife and I will declare $22,000 in medical costs when we file our income tax,” Michael Worner said. “This represents over 30% of our total income. Our prescription drug costs are a major part of this expense and cause us constant concern.”

Worner suffers from dry eyes, a condition that he said cannot be treated using over-the-counter medications. The medication Worner’s eye doctor prescribed him costs $1,700 for a three-month supply. After insurance, Worner’s out-of-pocket cost is around $120. 

“About two years ago, when I talked to my doctor and informed him that I was having difficulty paying for the expensive medication, he suggested that I use only half of the prescribed medication daily,” Worner said. “This is one method I use to save money – by rationing my drugs.”

Worner has started buying the medication out-of-country. He said a three-month supply of the drug costs $60 versus $1,700 in-country before insurance.

“A point of interest is that the medication that I purchase from another country is manufactured in Waco, Texas,” Worner said. “In my opinion, this is not right. Why can someone purchase a prescription drug for $60 when I am paying $1,700 for that same drug?”

Peter Fjelstad, senior director of state policy for Pharmaceutical Research and Manufacturers of America, testified in opposition to the bill. 

“This kind of legislation will not benefit patients and can jeopardize the competitive market that works to drive down drug prices,” Fjelstad said.

According to Fjelstad, price controls threaten the development of new medications because it reduces the incentive for pharmaceutical companies to invest in research and development. 

“It is not the right path forward to help ensure that North Dakotans have access to affordable medicines,” Fjelstad said.

SB 2209 and SB 2212 would establish a wholesale prescription drug importation program with Canada to lower costs. The two bills are essentially the same except the program would be run by N.D. Board of Pharmacy under SB 2209 and the N.D. Department of Health under SB 2212. 

Roger Roehl, a Mandan resident, testified in favor of the bills.

“Five years ago, I nearly lost my life to leukemia, but it wasn’t because of the disease, which was under control. It was because my wife and I couldn’t afford my medication,” Roehl said. 

Under Roehl’s Medicare insurance plan, his monthly medication cost was $2,400. Roehl said he was not able to afford the medication. After consulting with his oncologist, Roehl was told he would have approximately three and half years to live without the medication. Roehl later discovered he would be able to get his medication from Canada for $690 per month. 

“What good is a life-saving drug if you can’t afford to buy it,” Roehl said. “It’s a shame Americans have to turn to foreign countries for affordable prices on life-saving drugs but if that will help consumers like me, I support it.”

Aside from the medication Roehl takes for leukemia he is also now taking insulin, after side effects of COVID-19 elevated his blood sugar.

“I support anything you guys can come up with to help us out. We definitely need some assistance because we’re not getting anywhere on our own,” Roehl said.

Leah Lindahl, with the Healthcare Distribution Alliance, which connects pharmaceutical distributors with pharmacies, hospitals, clinics and long-term care facilities, testified in opposition to the bills.

“Allowing for importation of prescription drug products increases the likelihood of counterfeit or adulterated drugs entering the country,” Lindahl said. 

In her testimony, Lindahl referenced the Drug Supply Chain Security Act which establishes a program to track prescription drugs distributed in the United States. The program helps prevent citizens from using counterfeit, stolen, contaminated or other harmful drugs.

“Importation of drugs from Canada, or other countries, would hinder the intent of the DSCSA statute, and therefore increase the risk of illegitimate or counterfeit medications entering the U.S. market,” Lindahl said.

Daniel Weiss, senior executive director of pharmacy benefits at Sanford Health Plan, testified virtually on Jan. 6 before the N.D. House Human Services Committee on HB 1032, which relates to drug prescription costs. Virtual testimony over Zoom is now available during North Dakota’s 67th legislative session, which lawmakers hope will improve access for people across the state and lessen the risk of Covid-19.
NDNAEF photo by Dylan Sherman.

A pilot program for attending committee meetings online began in 2019, Bjornson said, but the COVID-19 pandemic exacerbated the need for alternative means of public access to meetings.

“We had concerns about making it accessible to as many people as possible,” he said. “Our IT staff worked really hard to design, to the best of their ability, a process that eliminates hurdles and makes it as easy as possible.” 

As with any new procedures, Bjornson said, there likely will be kinks along the way, but the state is prepared to fix any issues that come up.

Josh Askvig, state director of the North Dakota AARP, said the switch to online viewing and testimony is an opportunity for himself and association members.

“We have members who live in Grand Forks and Williston who have always wanted to participate, but that is a long drive to come down for a hearing,” he said. “Well, now they can watch it online from their home, and there are also virtual testimony options for them now.”

Askvig said understanding the new technology has less to do with age and more to do with an individual’s own comfort with technology.

“There are folks that are well into their 70s and 80s who will have no problem doing it,” he said. “The more they use it, the more they will be comfortable with it.”

Askvig said the state AARP has started training and working with members and volunteers on accessing the tools to participate in proceedings this year.

“Another approach we have been taking is [asking] what other ways can we encourage members to reach out to legislators,” he said. “Whether it be via email, phone calls or hand-written messages and post cards, those are all tactics that we have not relied on as heavily in the past.”

While usually a regular at the Capitol, Askvig said this session will be different as he will try to be more judicious about when he needs to be there in person. “[We want to make sure] legislators understand that when we are in the room, this is a big priority for us,” he said.

Askvig said this session will be weird even for himself when he has to testify virtually for the first time.

“I wish we could all be together,” he said. “Obviously the right steps and measures have been taken to encourage people to be physically distant and wear masks.” 

Rep. Robin Weisz, R-Hurdsfield, said it is great that people have more access, but he worries about online testimonies overwhelming his committee.

“[Anyone] can attempt to testify virtually, and it is up to me, as the chairman, to try to filter that out,” he said. “At least in my committee people that show up have priority.”

Weisz said he wants members of the public to have their voices heard, rather than leaving the virtual podium to experts from around the country. Virtual testimony also could make it more difficult to gauge the perception of the room, he said.

“I still think for most of us [on the committee], the personal interaction, facial expressions, mannerisms and reactions all help us kind of get a sense of who’s where,” he said.

Weisz echoed the concern that older constituents might not want to drive long distances to participate in a particular hearing. “People of my generation and older may be discouraged by it, but at the same time I am 75 years old – I don’t want to drive from Edgeley or Grafton and I can do it virtually,” he said.

Rep. Corey Mock, D-Grand Forks, said while it will be different without as much public in-person attendance, he hopes some of the changes will help people who can’t make the trip to the Capitol, this session and in the future.

“If members of the public are able to participate and want to testify, we are able to have them participate remotely,” he said. “I am hoping to see more engagement and participation from folks back home in Grand Forks.”