Special Edition Weekly Dose of Health January 24, 2017

Special Edition Weekly Dose of Health 

Notable healthcare proposals in the Executive Budget include the following:

  • $17.7 billion in state share spending for Medicaid
  • Proposed Medicaid spending of $63.2 billion for 2017 and $65.2 billion for 2018.  The budget continues the Medicaid Global Cap through 2019.
  • Additional Capital support for health care providers of $500 million and includes $30 million for community-based providers.
  • $553 million proposed for state’s health exchange operations.
  • $3.7 billion on the Essential Plan
  • Electronic cigarette regulation.

Detailed Budget Bill Proposals/Language:

  • Pharmaceutical-related Medicaid Redesign Team budget legislation (Part D).
    • This bill would establish a required supplemental rebate on the sale of certain drugs sold to the State’s Medicaid program at prices over a benchmark amount determined by the Drug Utilization Review Board (DURB), established by Social Services Law § 369bb. It would also establish a surcharge on the first sale of such drugs in New York State. The revenue collected from the surcharge would be held in a dedicated revenue fund and disbursed to health insurers in New York State to lower insurance premiums.
  • Legislation that authorizes Pharmacy Benefit Manager registration and disclosure requirements (Part J).
    • This bill would make statutory changes necessary to regulate non-Medicaid Pharmacy Benefit Manager (PBM) services through PBM registration and disclosure requirements in order to prohibit business practices that contribute to high prescription drug costs.

Helpful links:


  • Pharma Lobby Fights Back Against Trump Criticism with TV Ads
    • Big Pharma’s  lobbying arm is fighting back against outrage over rising drug costs from the public and President Donald Trump, who has the industry in his crosshairs.


  • Cuomo proposes prescription drug price controls.  The state will establish a new cost-control system to stop some “unconscionable” drug companies from gouging consumers with high prescription drug prices, Gov. Andrew M. Cuomo said Wednesday.
  • The state of New York has come up with a drug pricing plan of its own, as Governor Andrew Cuomo announced an innovative new proposal aimed at protecting residents from the menace of increasing prescription drug prices in the state.
  • Cuomo Frames His Populist Approach with Legislature
    • Gov. Andrew Cuomo’s speech in Plattsburgh was largely in line with his previous regional versions of the State of the State: He wants to make prescription drugs cheaper through state action, he wants county officials to work with municipal governments to develop tax-cutting solutions, he wants to phase out tuition costs at state colleges. But Cuomo’s remarks also at the end struck a populist note when it comes to pushing the Legislature to adopting his $152.3 billion budget plan.

The Pharmaceutical Supply Chain: Gross Drug Expenditures Realized by Stakeholder

PhRMA has been working with the Berkeley Research Group (BRG) on a study examining spending across the biopharmaceutical supply chain. This morning we released “The Pharmaceutical Supply Chain: Gross Drug Expenditures Realized by Stakeholder” study via an exclusive with Bloomberg, a press release and promotion across PhRMA digital/social channels.

Most conversations about prescription drug spending have paid little attention to the multiple stakeholders involved in the drug distribution and payment process.  This first-of-its-kind report sheds light into the roles played by these entities and demonstrates that a large share of spending for prescription medicines accrues to stakeholders other than brand biopharmaceutical companies.

Key findings from the study include:

  • Brand biopharmaceutical companies retained just $219 billion, or 63 percent, of total gross spending on brand medicines — meaning that more than one-third of gross spending on brand medicines is rebated back to PBMs, health plans and the government, or retained by other stakeholders in the biopharmaceutical supply chain.
  • Between 2013 and 2015, retrospective rebates, discounts and fees paid to health plans, PBMs and the government for brand medicines have increased from an estimated $67 billion in 2013 to $106 billion in 2015.
  • After accounting for discounts and rebates, the BRG report estimates that brand biopharmaceutical companies realized less than half (47 percent) of total U.S. spending on prescription drugs in 2015.

To help us promote the study, below are suggested tweets.

  • ICYMI: New study shows growing share of medicine spending going to generics, rebates & supply chain http://onphr.ma/2jKnHeZ
  • New study: Brand biopharma companies retained just 63% of gross spending on brand medicines in 2015 http://onphr.ma/2jKnHeZ
  • Study: Only 47% of total US prescription drug spending was retained by brand biopharma companies in 2015 http://onphr.ma/2jKnHeZ

Upcoming Events:

  • Health/Medicaid Joint Legislative Public Hearing, Thursday February 16, 2017, 9:30AM, Hearing Room B, Legislative Office Building, Albany
  • Click here for upcoming meetings, hearings, and events from the state Department of Health.