Some argue that Gov. Gavin Newsom’s budget for California doesn’t reduce the deficit enough. Budget hawks are suggesting an approach that disproportionately disadvantages patients with cancer and HIV/AIDS today — and threatens the medical innovations of tomorrow.
The California Department of Health Care Services (DHCS) recently released a trailer bill proposal to increase minimum supplemental Medi-Cal rebates for HIV/AIDS and cancer treatments. The proposal would also prevent patients from accessing cutting-edge medicines and force others to undergo a burdensome pre-approval process.
The bill would give DHCS the authority to disintermediate healthcare providers and unilaterally remove medicines from the Medi-Cal formulary. The proposal also restricts opportunities for public input on formulary decisions, giving the state almost unchecked power to make decisions that could impact the health of millions who depend on Medi-Cal.
While this proposal may sound like a good idea to the casual observer, the devil is in the details. While increasing rebates, this proposal does so without any assurances that these funds will benefit patients directly. If passed, it would decrease treatment access and disincentivize ongoing innovation into treatments for these life-threatening conditions.
It is a short-sighted grab for dollars to reduce the budget deficit on the back of patients relying on treatments to stay healthier and live longer.
As the proposal currently stands, there is no guarantee that funds from these increased rebates will increase patient access by lowering out-of-pocket costs or advancing access to breakthrough treatments. Don’t make the same mistake twice. Just last year, the state relied on a 500 million dollar loan from California’s AIDS Drug Assistance Program (ADAP) Rebate Fund — which covers crucial healthcare services for uninsured and underinsured Californians — to fill the budget deficit.
Those who do not learn from history are bound to repeat it. States that have turned to increasingly costly and unproven policy mechanisms — such as Prescription Drug Affordability Boards (PDABs) — in attempts to advance fair pricing and safeguard patient access to essential treatments, have found that these ill-considered schemes result in impeding patient access and raising costs.
Singling out treatments for patients with cancer and HIV/AIDS will increase the stigma that patients living with these (and other) conditions already face. Laying the blame for California’s budget woes on patient communities already managing complex health conditions, alongside the emotional, administrative, and personal financial burdens, is poor financial planning and demonstrates a lack of compassion.
These proposals are penny-wise and pound-foolish. Advancements in research and discovery save lives and money through reduced rates of HIV-AIDS transmission and better treatment of cancer at earlier stages, giving patients and their families hope and alleviating the strain on the health system overall.
Reducing the Golden State’s budget deficit must be a top priority. Still, proposals that aim to balance the budget without the crucial guardrails necessary to support patient access and future medical innovation are the wrong prescription. It is bad politics and policy malpractice. The best way to meaningfully address the gap between Californians and their essential healthcare is to develop plans to advance patient-centric programs that reduce costs and enable longer, healthier lives.
Bureaucratic sleight of hand that appropriates financial rebates generated through the purchase of treatments for HIV/AIDS and cancer in Medi-Cal should not be used to fill in the state’s broader budget gaps. Actions have consequences, and in this case patients will suffer them. Gov. Newsom must make sure the consequences result in healthier patients and enhanced medical progress.
Michael W. Hodin is the CEO of the Global Coalition on Aging. Peter J. Pitts, a former FDA associate commissioner, is president of the Center for Medicine in the Public Interest.
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