Stay ahead of the curve as a political insider with deep policy analysis, daily briefings and policy-shaping tools.Request a Demo
- Medicare prescription-drugs have skyrocketed 89% in Georgia from 2013 to 2019.
- Prices for common medications in Georgia have also ballooned during that time.
- Cost transparency is lacking even from state government as key prescription-drug players blame each other.
While Medicare data hint at rising medication costs across the board in Georgia, research by NiceRx shows prices for many high-demand prescription drugs have also ballooned – including for several drugs that Jackson needs. Jackson said she takes the brand-name drugs Lyrica and Trulicity to help keep her migraines and Type 2 diabetes in check. NiceRx’s findings show average prices for both drugs shot up between 2012 and 2017:
- 137% increase for Lyrica: from $174 per fill to $411
- 35% increase for Trulicity: from $497 per fill to $674
Other common prescription drugs in Georgia have also rocketed up in price. The American Association of Retired Persons (AARP) Georgia chapter estimates the cancer drug Revlimid shot up from an average of roughly $185,500 per year in 2015 to nearly $270,000 in 2020. A 2020 congressional report traced Revlimid’s steep price hikes to a desire by executives for its manufacturer, the New Jersey-based drugmaker Celgene, to “meet company revenue targets and shareholder earnings goals.”
Similar price spikes have been seen for common drugs that treat diabetes, asthma and chronic obstructive pulmonary disease, according to the AARP’s findings. Medicare and other health plans cover most prescription drug costs to keep them affordable. However, many low-income Georgia residents and seniors on fixed incomes still struggle to make up the difference for what’s not covered, said Nancy Pitra, AARP’s Georgia associate state advocacy director.
“They’re having to pick and choose between paying for medications and buying groceries,” Pitra said in a recent interview. “That’s not living at all.”
Sometimes, even local Medicare providers decline to cover certain drugs that doctors insist their patients need. Decatur resident Alex Roetger has butted heads with his Medicare provider over an inhaler made in Germany called Spiolito Respimat that his doctor prescribed for respiratory issues but which he said comes with a price tag of $500 every other week.
The inhaler has worked wonders in the year or so since Roetger began losing his voice, and it doesn't contain steroids that “tear my lungs apart,” he said. But while his Medicare provider covers costs for some inhalers, Roetger said it won’t pick up the bill for the one his doctor prescribed.
On top of other medications he takes for high blood pressure, Roetger said he can’t afford to add a $12,000 annual tab for the inhaler to his budget in retirement. He’s now waiting to see if any outside groups will help whittle down the costs. Until then, Roetger expects he’ll need to ration the free inhaler samples that his doctor gave until they all run out.
“What I’ll do is what every other senior does: I’ll cut the dosage in half,” Roetger said in a recent interview. “Then a third, then a quarter. Then you just give up.”
Roetger is among many seniors and low-income Georgia residents who rely on outside help from groups like GoodRx to subsidize their drug costs. Some drug companies also offer grants to cover costs, such as for the brand-name drug Enbrel that Jackson takes for rheumatoid arthritis. The need for many Georgia seniors to lean on outside funding to pay for medications when they already have health insurance frustrates local advocates like Ellen Miller-Mapp, a member of the senior advocacy group LeadingAge Georgia.
“It’s falling to the end consumer to go through complicated choices to get relief,” Miller-Mapp said in a recent interview. “As a country, we just have not done well by our seniors. There’s just no other way to put it.”
Doctors in Georgia have also seen cash-strapped patients delay filling their prescriptions or ration what drugs they have to make ends meet. State and federal lawmakers need to double-up efforts on passing regulations to clear away transparency hurdles that hurt patients, said Tom Kornegay, a spokesman for the Medical Association of Georgia.
“Patients delay, forgo or ration their medication when treatments are cost prohibitive – which undermines their health,” Kornegay said in a recent statement. “(We believe) that the best way to reduce health care costs is to reduce the massive administrative burdens that don’t have anything to do with patient care, including billing.”
A study committee of Georgia senators took a decisive step Tuesday toward ending a longstanding and contentious law that regulates how and where new medical facilities are located in the state.
The committee’s decision centers on the 44-year-old Certificate of Need law. It was created to control health care costs and cut down on duplication of services and unnecessary expansions. It determines when, where and if hospitals need to be built. Opponents have said the law prevents competition and enables big hospitals to have a monopoly, often shutting out small and private medical outlets.
On Tuesday, the Senate Study Committee on Certificate of Need Reform effectively said the law needs to be repealed. The committee approved, in a 6-2 vote, nine recommendations.
“Based upon the testimony, research presented, and information received, the Study Committee on Certificate of Need Reform has found that the problem Georgia’s CON law was intended to combat no longer exists,” the report said.
However, the head of the Georgia Alliance of Community Hospitals said Tuesday that repealing the law would be a bad idea.
“It would have a devastating financial impact on hospitals and the quality and access to health care,” Monty Veazey, the alliance’s chief executive, told State Affairs.
Veazey said he has not seen the recommendations yet but his organization has sent its own set of recommendations to the senate and house study committees.
“We believe that the certificate of need really does need some modernization and we look forward to working with the committee to work through those recommendations and see if we can reach a compromise position during the upcoming legislative session,” Veazey said. “We still want to see what the House committee recommends before moving forward.”
Here’s what the senate study committee recommends, according to a draft:
- Repeal CON requirements for obstetrics services, neonatal intensive care, birth centers and all services related to maternal and neonatal care across Georgia.
- End requirements for hospital-based CON on Jan. 1, 2025.
- Reform CON laws to eliminate CON review for new and expanded inpatient psychiatric services and beds that serve Medicaid patients and the uninsured.
- Repeal all cost expenditure triggers for CON.
- All medical and surgery specialties should be considered a single specialty, including cardiology and general surgery.
- Multi-specialty centers should be allowed, particularly in rural areas.
- Remove CON for hospital bed expansion.
- Revise freestanding emergency department requirements such that they must be within 35 miles of an affiliated hospital.
- Remove CON for research centers.
The committee will present its recommendations to the Georgia General Assembly when it reconvenes in January.
And subscribe to State Affairs so you do not miss an update.
ATLANTA — The first step in the 2023 electoral redistricting process occurred Monday when Sen. Shelly Echols, R-Gainesville, chair of the Senate Reapportionment and Redistricting Committee, released a draft proposal of new Senate district maps.
Last month, U.S. District Judge Steve Jones ordered Georgia to redraw its state House, Senate and congressional district maps, adopted in 2021 by a majority-Republican-led Legislature, after finding they violated the Votings Rights Act by diluting the power of Black voters. The Georgia General Assembly is charged with submitting new maps to comply with Jones’ order by Dec. 8, and will be meeting in an eight-day special legislative session to do so, starting on Wednesday.
The proposed Senate maps would create two Black-majority voting districts while eliminating two white majority districts in metro Atlanta now represented by Democrats. The districts of state Sen. Elena Parent, chair of the Senate Democratic caucus, and Democratic Sen. Jason Esteves, a freshman, would become majority-Black if the redrawn maps make it through the redistricting process, a change that could invite considerably more primary challenges.
The proposed maps do not significantly alter the district lines for Sen. Valencia Seay, D-Riverdale, and Sen. Marty Harbin, R-Tyrone, whose districts Jones ruled did not comply with the Voting Rights Act. It will be up to Jones to decide if the new maps pass muster.
As it stands, the proposed Senate map will leave Republicans with a 33-23 advantage in the Senate.
On Wednesday legislators will plunge into their redistricting work during a special session at the Capitol. In addition to the state Senate maps, lawmakers must also redraw electoral maps to create Black majorities in one additional congressional district in west-metro Atlanta, and in five additional state House districts in Atlanta and the Macon-Bibb County area.
The proposed Senate maps (and all proposed maps to be submitted by legislators) are available on the Legislative and Congressional Reapportionment Office’s website. Written comments can be submitted (and viewed) by the public through the portal available on the Georgia General Assembly website. Most of the reapportionment and redistricting committee’s hearings are open to the public; the daily legislative schedule is available here.
“The committee encourages public participation and values the input of the community in this vital democratic process,” Echols said in a statement released on Monday.
Subscribe to State Affairs so you will have unlimited access to all of our stories.
Veteran government and political aide Lauren Curry has been named Gov. Brian Kemp’s chief of staff, becoming the first woman in Georgia’s 235-year history to hold that title. Curry, currently the deputy chief of staff, assumes her new role on Jan. 15. She succeeds Trey Kilpatrick who has accepted a job with Georgia Power as …
ATLANTA — An invitation-only tribute service for former first lady Rosalynn Carter will be held at 1 p.m. today on the campus of Emory University at Glenn Memorial United Methodist Church. Former President Jimmy Carter, who has been receiving hospice care at home in Plains since February, is expected to attend, along with other Carter …