 I'm Marcia Martin and this is the 2021 version of Capital Conversations and I am here with our state senator, Sonia Hockas-Lewis and she is here to talk about what we are doing to help the public along with their prescription drug costs, which I know is a big issue for many, many people. Senator Lewis is a pharmacist and we love to have these people in the legislature with technical know-how. Sonia, please take it away. Thank you, Marcia. I really appreciate the opportunity to talk about healthcare. So as the first pharmacist ever elected to the house, and now I'm serving in my first session as the state senator from Senate District 17, my wonderful home of Longmont and Lafayette and Louisville and that sliver of eerie in Boulder County, we can't forget. We know that the number one issue right now in Colorado and in the United States is really our healthcare. Obviously living in the age of COVID and this dreadful pandemic with the loss of life that we've seen, we have to do everything we can to make healthcare accessible and at the same time address the life-saving prescription drugs that people rely on. So before COVID hit, reducing prescription drug prices was the number one issue and as we have now lived through this pandemic, it remains the number one, if not the very top because what we found is that COVID has shown a light on health disparities in our community. Not everyone can get access to a doctor and can can get that access to those prescription drugs that they need. While I was a pharmacist practicing, there wasn't a week that went by where someone wouldn't come in and say, I've got this budget for my groceries. I've got a budget for my prescription drugs. They're not matching. I can't do this. They would hand me, we call it a brown bag and hand me a bag of prescription bottles and say, which one can I do without this month? And I mean, that is heartbreaking. We are the wealthiest, the greatest country in the world and we can't get prescription drugs for our citizens and residents. That makes no sense. So I'm looking at introducing and we start back on February 16th for our 2021 session. We'll be introducing several bills to help with healthcare. The first one is a prescription drug affordability board, which will review the drugs and if they are affordable or not affordable. And the reason why we're looking at doing it that way is because the United States is one of two countries in the entire world that do not take a look at affordability for prescription drugs and the other country is American Samoa. So it just, again, it is a travesty that we can't negotiate. We're not allowed to look at what drugs cost for Americans and we can fix that here in Colorado. And one more piece about this bill that's important to know is that it's already passed in other states. We've had two states that have already passed a form of this and we now have six states that are looking at doing it for their session this year. So Colorado is a little behind when it comes to doing something about reducing the price of prescription drugs and this will get us back to where we need to be because this is really a vital issue for so many people. Yes, and what you said about COVID and what we are seeing is that it's a real social equity issue because the people who have been rationing their own healthcare for financial reasons are more vulnerable. They're not as healthy and so they're more vulnerable to the ravages of the pandemic. And it probably isn't the only reason why persons of color in Colorado have a higher infection and a higher death rate, but it's certainly one of the reasons. Right. You're hitting it right. You're hitting the nail on the head, Marcia, because we have black and brown communities in our area that have, you know, double, triple the death rate from COVID. There's many reasons that contribute to that, but one big one is access to proper healthcare. And, you know, we could go on and on about the reasons of how we got into this depth of this pandemic, but certainly now I commend the governor for trying to get the vaccine out as quick as he can, but we need to do more because even the most recent numbers released by the Colorado Department of Public Health and Environment, CDPHE, one of our acronyms, is that more white affluent Coloradans are getting the vaccine compared to communities of color, communities of disparity. So we need to basically address making the vaccine more available and making healthcare in general and prescription drugs more affordable. So I'm hoping that this bill, as it's doing in other states, and we've seen other countries do it, I'm hoping that this will go a long way. Do I have time to talk about a few more bills that are coming? Yes. You have all the time that you would, you want to give us, although we do try to keep these a little bit short because people's attention wanes, you know, and I'd rather have, I'd rather have several that get watched end to end than, you know, one that's too long. But please go ahead. Great. I want to talk about the unfairness of why we're looking at this, like what makes us want to do it now, and what is happening in prescription drugs in general. So let's look to our neighbors to the north. If you look at what Canadians, as an example, and they're very public about the way that they do their prescription drug plans and the way that they purchase and supply prescription drugs. So their prescription drugs are the listing and the cost of those drugs is public. So if you look at the way we do prescription drugs, it's very secret. For instance, if you go to one pharmacy, it's going to be one price. If you go to another, it's going to be another. If you have Medicare, you pay a different amount than if you have private insurance. And this is really what makes this issue so complex. And one of the main reasons why I decided to run for office, because as a pharmacist and as a former Medicaid pharmacy director, I understand those dynamics. So let's look at just one drug. If there are any viewers that might be familiar with Humira, that is a product for rheumatoid arthritis. It also treats Crohn's disease. It also treats psoriasis. And actually, I could go even into more, but let me stop there. In the United States, a list price for a one month supply of the syringes is about almost $3,000. And that's on one pricing mechanism. Do you know what they pay in Canada? It's $550. Yes, we have a huge disparity. Let's pick an area that is really of concern to me. If you look at a cancer drug, this one is for prostate cancer. It's called Zytiga. In the United States, for one tablet, one tablet, it's $87.63. In Canada, it's $21. Why? Why it's the same manufacturing. It's the same company that makes it. Why is the United States subsidizing the rest of the world for prescription drugs? This bill, having a prescription drug affordability board, will even the playing field for Coloradans. Do I wish that this was being done federally? Of course I do. But can we wait until they take action? I don't think so. So that's why I'm introducing this bill. Good. So do you know why? In other words, is the underlying mechanism understood and we just can't do anything about it now? It's a great question. It's because America can't negotiate drug prices. That's as simple as that. When we put in the, for instance, there may be quite a number of your viewers that remember there was a time in Medicare where Medicare didn't pay for prescription drugs. When that bill went in, it was called the Medicare Modernization Act. It was passed in 2005. I actually helped work on that bill. Prescription drugs were added. That coverage was added. However, there was a clause that was put into that bill that said that drug prices could not be negotiated by the United States government. That is one of the main reasons. The other reason is that really companies, pharmaceutical manufacturers for years, have been able to say, well, we need to raise, keep raising the prices because research and development cost a lot of money. It's not the case anymore. We have multiple drugs that are specialty drugs or cancer drugs that even a recent CEO of a company said, out of $100 a month or $100 a tablet drug, they're paying pennies for the manufacturing. They can do it. They can get away with it. This has to stop. This unfairness, we can do something about it. This is the subsidy that you're talking about that essentially the drug companies are getting a really fast payback for their R&D investments. They could probably afford a longer payback that was not entirely on the backs of the mayor. You've got it. We already have a very long payback time for branded drugs. Those drugs would be said to be under patent. We have a long payback time for them, 15 to 17 years. It's one of the longest patent times for any industry. You don't see someone introducing a computer and then nobody else can introduce a computer similar for 15 to 17 years. That's unheard of. We really have to address what the root cause of this inequity is. This bill establishing an affordability review process will do that. Will the drug companies be required to make any kind of disclosures about what their R&D investments were as opposed to manufacturing costs, etc.? We have no transparency right now at all from pharmaceutical manufacturers. They're not regulated in Colorado the way they are in other countries. We're not trying to set any prices. We're not trying to say you can make this or you can't make this. We're not doing that at all. What we're doing is we're assessing is the product based on other competitors, generics, other brands, what's happening in the marketplace, the number of uses of the drug, supply issues, all of those things. We're assessing is this drug affordable when you look at all of it? Here's the interesting thing about that. In the United States, we already have some groups that are doing that, but they don't have any power to control where we go with that information. Now, every other country in the world, except American Samoa and the United States, has those kind of review boards and they look at comparing drugs and what's affordable and what's not. That's the direction that we need to have. Again, I would love to see this be something that we do on a nationwide basis, but we're not there. I will say that it's leaders in our country, like our state, like Maryland, like Washington, California, Rhode Island's looking at it, North Dakota's looking at it, Oklahoma's looking at it. If enough states get together and do this, I think that what's that saying about rising tide raises all votes. Hopefully, we'll be able to have the federal powers that be. Take a look at doing this. Well, that's a good thing and I have heard Governor Polis say before that he's looking at interstate alliances, too, as a lever about healthcare costs in general. Yes, that's a great lead in for, I think, another piece of legislation that I know is coming. And by the way, Governor Polis is a big fan of the approach that I'm taking on this legislation. We have what I think will be coming is the public option. That bill was introduced. There was a study that was done. It passed in 2019 and now we have some of the study information back. And I believe you're going to see a public option bill that will allow other counties. And I don't, I can't say for sure if it's a regional alliance, but we can look at what other counties are doing. And hopefully in the public option and the reinsurance that was done, that allowed premium prices to drop by 18 to 20% for some folks. So this is another wonderful aspect that we're looking at for reducing general healthcare costs and insurance premiums. So I think that that's another avenue that we'll be heading down this coming session. Good. So I can see two things about that. One is, is that because of the Colorado's distribution of population and industry, the burden of private insurance falls very heavily on our rural communities that don't have as much income. Right. So that'll be not as much choice of insurers. Yes. Right. Before they passed the reinsurance, they, I should say me, I voted for it too. Before we passed that in 2019, we had, I believe it was 12 counties in the state that only had one insurer. And that obviously is a monopoly, right? I mean, we're looking at that across the board. We can't, we have to have competition. Our country was built on being able to keep things affordable by having a fair and great playing field for everyone. And it should be true for healthcare. So I think that we'll be looking at something like that too. And if I can spend one more minute on where we're going, a great with healthcare, I think there's been a huge commitment to mental healthcare. In fact, in the house where I just finished serving for two years, they've even realigned the public health committee to be public health and mental health, which is wonderful because now we can give more increased attention and resources to looking at improving our access to mental healthcare. So I think that's another area that we can improve in in Colorado. We need more mental health providers. We need more mental health providers who are bilingual. We need access to medications for mental health. So there's so many things that we can do to look at behavioral health for our, for our Coloradans. That really strikes a chord with me because when people fall out of, of the organized world because of mental health issues, they become a burden on the municipality. And, and the city is doing things that it really is not equipped to do because we don't even have a public health department, but we're responsible for the people who are on our streets. Right. And, you know, Longmont has been a leader in doing partnerships with some of the police groups that are, you have police officers going out, social work officers going out. You probably know the name of the program, which escapes me right now. The initiative is one. There it is. I mean, that's, that's what we need more of. I know when I served on the Boulder County Board of Health, we had some of the same people we, you know, in the Medicaid world, we call them frequent flyers. And I think that's pretty obvious to your viewers what that means, but we had some of the same people coming in and out of the ERs in our community at the hospital. And that's just, that's not the kind of treatment that we need to be able to have those folks access. And that is something that I think that this improved focus on mental health by realigning our committees and looking at our policies that we can, we can get there. So that, that's another big commitment that I know this session of the legislature is going to be looking at. That's an important thing. We need to get Colorado back into being a model for the foundation as we are in other areas. Senator Sonia Hakez-Lewis, I very much enjoyed this conversation and thank you so much for being so generous with your time. Thank you, Marcia. I always enjoy coming to talk about what's going on at the Capitol. So I appreciate you inviting me. We'll do it again soon. Thank you.