An executive order consolidating prescription drug acquisition pricing in California has already been signed and taken effect. As Governor Newsom took to social media to explain, this means Medi-Cal (roughly 2 million Californians alone), CALPRS, Dept. of Veterans affairs and Dept. of Corrections and Rehabilitation will now bargain collectively for prescription drug acquisition price contracts covering roughly 13 million covered lives. This contemplates a long overdue expansion of Medi-Cal's mighty purchasing power to other non-Medi-Cal entities that have had to acquire certain prescription drugs at prices that reportedly far exceed Medi-Cal's acquisition cost. I have blogged about this before.
Such a change would likely markedly impact the Department of Corrections most immediately, where California's sentencing practices have created a demographic where a significant percentage of the prison population is of advanced age as well as medically complex. The Department of Corrections has been candid about its disappointment in being denied Medi-Cal acquisition rates for prescription drugs.
Just what is the spread between Department of Corrections and Medi-Cal's prescription drug acquisition cost? Ah, that is — in part — proprietary information. The pharmaceutical manufacturers do not want the left hand to know what the right hand is doing, lest other government agencies demand to be in on the deal and lest private purchasers also demand Medi-Cal acquisition cost pricing.
You see, California's lower prescription drug discounts could be from the undisclosed cross-subsidization of others, precisely those others who now seek to access the Medi-Cal acquisition cost.
So, who's left to the be cross-subsidizer? Buyers in other states? As Governor Newsom notes in his video, California's actions here may well create incentives for other states to follow suit. This could get interesting.