Senate moves forward to cap prescription drug prices
Photo I Sam Drysdale / SHNS
Sen. Cindy Friedman (D-Middlesex) presides over a hearing at the State House on April 2.
The Senate voted Wednesday to add a major prescription drug price control measure to their fiscal year 2026 budget, drawing the ire of the influential life sciences sector and adding another major topic to House-Senate negotiations on the horizon.
After nearly 90 minutes of debate about financial burdens on patients, pharmaceutical industry lobbying, and legislative process, the Senate voted 34-5 to attach to the budget policy reforms authored by Health Care Financing Committee Co-chair Sen. Cindy Friedman.
The 23-page amendment (#541) would allow Health Policy Commission regulators to place a maximum price limit on some medications, capping what patients, providers, pharmacies and others in Massachusetts would pay.
Friedman said the measure would task the HPC with creating a "robust, transparent process for evaluating drug costs." If the agency determines the cost of a medication "substantially exceeds the proposed value," Friedman said, it could set an "upper price limit" reflecting "the most that anyone in the state will pay."
She added that only certain "public health drugs" would be affected and that the HPC could not "just pick any drug and say, 'We're going to do that.' " Pharmaceutical manufacturers would be in close contact with regulators during the process.
Friedman acknowledged the proposal would generate controversy among an influential industry, and suggested litigation is "likely."
"If we are really serious about bringing relief to our residents, to our constituents, to patients, to the whole system, then we need to take action and we need to do that now," the Arlington Democrat told her colleagues. "It is not perfect. Nothing will ever be perfect in this space. But we have to show that we, as a body, are willing to take steps that we believe and that we trust each other to help us figure out what those might be."
All four Senate Republicans voted against the amendment, as did Quincy Democrat John Keenan.
The proposal drew criticism from the biotechnology and pharmaceutical sector, and it adds another hefty topic to the growing list of differences that House-Senate negotiators will need to address when they settle in to craft a final compromise spending plan. The House did not include a similar prescription drug pricing control measure in their version of the budget, which covers the fiscal year that begins July 1.
A handful of states have implemented similar reforms so far, including Colorado, Minnesota and Maryland, according to Friedman. She said Massachusetts, if it joined the list, would be the furthest along because the HPC has existed for more than a decade, whereas other pioneering states needed to stand up new regulatory agencies to handle the responsibility.
Several states have also been tied up in legal battles over their efforts.
"[If the pharmaceutical industry] can't prevent a policy from being signed into law, they take their fights to court. That is their right. They have endless resources in allowing them to do this. We can't stop them, nor should we stop them," Friedman said. "They sued Colorado before that state even set up an upper payment limit, and they sued Maryland over a different but related policy. If they sue us, as is likely, it does not mean we've done anything wrong. Litigation is just a part of their strategy. Fortunately, every time they sue, we can use their arguments and the court's opinions to refine our own language."
Ed Coppinger, a former state representative who heads up government affairs at the Massachusetts Biotechnology Council, said Wednesday there is "no evidence that Upper Payment Limits reduce what patients pay at the pharmacy counter, and the handful of states that have the authority to implement them have yet to save patients any money."
"Instead, in addition to raising significant legal issues, [upper payment limits] introduce dangerous supply chain disruptions, force pharmacies to drop critical medicines, and destabilize the investment environment we rely on to discover and deliver future cures," Coppinger said in a statement. "UPLs may sound like reform, but they’re bad for patients, bad for science, and bad for Massachusetts. Given all these issues, we do not understand why the Senate intends to enact such problematic legislation through a budget amendment without following through with the legislative process."
Stami Turk, a spokesperson for national trade group PhRMA, argued that the Senate's proposed payment limits "is a harmful approach for patients."
"Including broad drug pricing measures in the Senate budget -- without engaging all stakeholders or holding a public hearing -- won't solve the real issue of affordability," Turk said in a statement. "In fact, it risks drug access across the state."
Beacon Hill last term enacted a significant new law designed to lower prescription drug costs, and Friedman described the price cap amendment as "one more step in that direction."
The measure sets up a difficult political battle. Beacon Hill views the biotechnology and pharmaceutical industries as key to the state's success. In last year's economic development bond bill, lawmakers and Gov. Maura Healey authorized another $500 million to support life sciences companies in the next decade.
Sen. Mark Montigny of New Bedford said he has long wanted to impose stricter limits on the prescription drug industry and lamented "how long this BS has gone on."
"We have a chance to lower prescription drug prices, but you don't get to do it unless you're willing to push back the industry that everyone thinks has saved the world because pharma is biotech, period," he said.
Montigny later added: "Here's the bottom line: You enter a regulated business, you get regulated. It's inconvenient. You don't like it? Go produce widgets."
The amendment is based on a larger, 118-page bill Friedman filed (S 868), which is pending before the Health Care Financing Committee she co-chairs. The panel has not scheduled a hearing on the legislation this term.
When other senators pointed out the underlying bill has not yet received a hearing, Friedman argued that prior iterations received extensive public review in past terms.
"We have been doing this particular bill-slash-amendment since 2019. Every time we learn something new, we update it, but it's fundamentally the same thing we've been talking about," she said. "So if you have been following it and you have enough of that information, you can easily read this thing and see where the differences are."
Health care costs in Massachusetts are soaring, and analysts have cited prescription drugs as one contributing factor.
Total health care expenditures per capita grew 8.6% from 2022 to 2023, more than double the benchmark that policymakers set as the goal for cost-containment. Pharmacy spending increased 10% in that span, the data show.
President Donald Trump is also seeking to reduce prescription drug prices using his executive authority.
Keenan was the lone Senate Democrat to oppose the amendment. He said he agrees prescription drug costs need to be addressed, but had concerns about adding a major policy rider whose standalone bill has not yet received a hearing this term to the budget.
"On a 23-page amendment that is a bill that's in committee that hasn't had a hearing, a bill that's different from last session, I'm just not so certain that this is the time or the place to take it up," Keenan said.
Keenan added that he's concerned the addition will "delay" the incoming conference committee's work to craft a final state budget, which is due by July 1. (Lawmakers for years have kept their negotiations going into the start of the next fiscal year and used stopgap budgets to fund state government in that span.)
Responding to Keenan's concerns, Friedman said prescription drug costs are "a major budget-buster."
"If this doesn't belong in a budget, I'm not sure where else it belongs. This is having a profound effect on how we use our resources in the commonwealth, and if we don't address this issue sooner rather than later, we will be in major trouble," she said. "Our hospitals are in major trouble because of this, our insurers are in major trouble, our state is in major trouble, so this, in my mind, is absolutely the right place for this."
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