In the Legislature, House and Senate versions of the Pharmaceutical Availability and Affordability Act (HB4084) have now passed. The Senate rejected the House version; the House returned the favor.

The House version initiates a long-range solution to the high cost of drugs for all West Virginians, with the promise of years of litigation in the offing. The Senate version offers various new programs available to, or of use to, a relatively small segment of West Virginians.

The House version would force drug makers to adhere to a federal price schedule. House leaders applaud their bill's direct confrontation of the underlying causes of high drug prices: drug manufacturer monopolies and excessive profits.

The Senate programs are voluntary on the part of drug manufacturers, with no penalties for nonparticipation. Senate leaders applaud their bill's immediate relief.

On the surface, the biggest difference between the bills lies in a choice between long-range and short-term solutions. Philosophically, the difference between the bills centers primarily on whether the practices of drug manufacturers are seen as the underlying source of the problem (House) or the means to its solution (Senate).

So what is West Virginia to do? The worst thing would be to do nothing - to let the bill die in conference committee.

The need for relief from rising drug costs will not change; it will only grow worse. The issues will not change; they will only intensify.

And there is no reason to believe that future legislatures will have any more will or commitment or common sense than the one now sitting.

Recent court decisions sustaining charges of inflated pricing by drug manufacturers and allowing innovative state remedies suggest now may be as good a time as we are likely to get in the near future.

How, then, do we move forward? First and foremost, we must create the opportunity for further dialogue and, indeed, compromise, in an honest joint committee effort. That said, where might there be agreement? What might a resolution look like?

Above all, we need both short-term remedy and long-term solution.

A Web-based prescription drug clearinghouse, as envisioned in the Senate bill, can be a useful tool. While it neither creates new programs nor lowers drug prices, it does help citizens access current sources. Such a program is clearly useful.

And expanding existing drug manufacturer discount programs as envisioned by the Senate cannot hurt - provided that it does not serve as an excuse to do nothing else.

The compromise bill should be tweaked into some semblance of effectiveness. The limitation to those with household incomes under 200 percent of the federal poverty limit ($24,980 for a family of two) might be raised to 350 percent ($43,715 for such a family), as in existing Maine and Hawaii prescription programs.

Some mechanism should be included to persuade manufacturers to participate (or punish them if they didn't), and some minimum level of discount should be stipulated. Some reasonable longevity for the program should be ensured. To simply leave all this to the goodwill of the drug manufacturers is foolhardy at best.

That brings us to the area of the Cost-Containment Authority (Senate version) or Pharmaceutical Commission (House version). Interestingly, the entity labeled "cost containment" is least likely to contain costs. The House entity is empowered to act in a variety of ways, including purchasing of drugs for all state agencies. In the Senate version, the entity is only empowered to explore such issues.

More to the point, the House bill is predicated on two major points: one, the "agreement requirement" that the cost of pharmaceuticals available to state programs cannot exceed the Federal Supply Schedule price plus a dispensing fee; and two, advertising and marketing costs cannot be invoked as justification for increases in drug prices.

While many in the House may wish to maintain these provisos, and even claim that they are central to their proposal (as well they are), insistence on their inclusion is almost certainly a deal-breaker for the Senate.

Yet the new bureaucratic entity, whatever its title, should be given more than investigatory powers. Study after study in state after state has already documented the underlying dynamics of increasing drug prices. Any administrative entity worth creating should be empowered to respond.

While the state may not be ready to implement a federal-level price program at this time, we should be ready to actively investigate the implications of such a program.

We should be ready, today, to monitor and work with other states in this effort. And we should be prepared to follow the lead of other states as they establish legal bases for programs involving leveraging the state's buying power, without having to go back to the Legislature for approval.

Much work has been done on both sides of the Capitol in an effort to achieve both immediate relief and the beginning of a long-term solution.

The question now is not which legislative body wins or loses, but whether West Virginians are truly better off next week, and five years from now, than they were a week ago.

Kurland is health action coordinator of Covenant House.

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