Opinion | Who should control Michigan’s medicine cabinet?

In an effort to “do something” about prescription drug prices, some Michigan lawmakers want to copy an initiative passed in several states, most notably Colorado. The proposed Prescription Drug Affordability Board would set price caps on medications it deems too expensive. Before Michigan lawmakers import this misguided policy, they should consider whether they want an unaccountable board to control the state’s medicine cabinet. 

The potential ramifications of handing over decisions about access to prescription medicines to a new unelected state board are huge. Similar proposals were recently vetoed in Virginia. And it failed four times in the Wisconsin Legislature, including getting voted down again last month. Before Michigan follows in Colorado’s footsteps, the public should be asking lawmakers five important questions.

1. Why are advocates for patients with rare diseases, who are often most impacted by drug pricing decisions, excluded from the board’s represented members? The proposal requires a patient advocate but the patient groups often facing the cruelest diseases and fewest treatment options are left without a voice.

2. Why does Michigan’s proposed law not ban the use of “quality-adjusted life years,” a controversial metric that devalues the lives of the elderly, those with physical and mental disabilities, and chronic conditions? The use of this measure has already been outlawed in the federal Medicare program and should not be allowed here. Michigan lawmakers must ensure that they don’t hard code discriminatory treatment against the most vulnerable patients in creating this board.

3. Who will get the “savings” the board is tasked to create? There are no guarantees or provisions that any savings achieved through price caps and restrictions will be passed on to consumers. The result could be zero financial relief for patients with access to fewer treatment options.

4. What is the recourse for vulnerable patients subject to the board’s decisions? Colorado has targeted a popular arthritis medication for potential price controls and restrictions. According to Michigan's own health data, arthritis is more prevalent in the state than the national average. In addition, the disease burden of arthritis can also affect the ability to work, may disproportionately affect those in the manual trades and affect those who are older. The repercussions of ceding authority over important health care decisions to an unelected and unaccountable board will be far-reaching.

5. Will Michigan lawmakers themselves be subject to this board? Lawmakers serving in the Michigan House may participate in a state-sponsored plan that is governed by federal law. As proposed, this health plan would be exempt from a prescription board’s decisions. Before Michigan lawmakers hand over power and authority for critical health care decisions, they should be willing to operate by the same set of rules and consequences that they would impose on their constituents.

While the interest to reduce drug prices is commendable, a willingness to move forward without protecting patient access to treatments and with no accountability to citizens is a perilous prescription. Programs cannot be evaluated by their intentions. Outcomes matter and they matter even more so where patient well-being is concerned. Michigan’s lawmakers should learn from others’ mistakes and dangerous examples, not double down on them.