Q&A: Asm. Nazarian talks prescription drug costs and planned legislation for 2022

Asm. Adrin Nazarian (D – Los Angeles) has served California’s 46th Assembly District since 2012. He currently chairs the Assembly Aging and Long-Term Care Committee and sits on the Health Committee.

In this Q&A, Nazarian discusses his health policy priorities for the upcoming legislative session, including lowering prescription drug costs and improving consumer experiences at pharmacies.


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Soraya Marashi: What are your health policy priorities for the upcoming session?

Asm. Adrin Nazarian: “In California, 60-year-old-and-over residents are growing on a daily basis … Today, they make up about 14% of the state’s population. In another 15 years, they’re expected to become 25% of the state’s population … which means more people shifting from the workforce into retirement … [which] means more competition between the major sectors of innovation [and] technology, versus people providing care and services. 

So we need to make the important investments to make sure that there’s going to be that workforce coming up in order to be able to meet these needs and demands for health care [for]the elderly … What’s ending up taking the lives of our elderly is the neurodegenerative diseases–all forms of dementia, Alzheimer’s, Parkinson’s. And these are areas that we still are in the infancy of trying to … elongate lifestyle in a way where they’re living comfortably, or coming up with certain types of mitigating vaccines. 

But it’s so early in this stage that these are going to be very costly diseases for us to deal with, especially with a growing population. So it’s going to be critical for us to look at what kind of a down payment we’re paying right now, for those that are 20, 30, 40 years old, so that … when they become seniors, [there is] a long-term care paid plan that’s going to cover their health expenses on top of the health insurance that they need. These are some of the big picture things.

As for some of the more individual bills that I’ve been working on this last year … I’ve already run two different bills on [insulin affordability], trying to make sure that we either get rid of co-pay or we get rid of the deductibility. Given the impact [of] diabetes … [it] tells you what kind of a cost driver this is going to be. Insulin itself that’s utilized and manufactured by multiple different companies has not changed in 80 years. But yet the price has gone up multiple folds, especially in the last 10 to 15 years. So we need to make sure that we’re [making] that cost affordable, especially when the technology isn’t really changing.

And then I’ve been working on a plasma-related bill now for several years, so that plasma donation centers can expand in California … That’s going to help a lot of different health care initiatives. And then there’s a couple of other issue areas [I’ve been working on] … real-time pharmacy is aimed at reducing costs so that when you’re going to the pharmacy with a prescription, you already know what the cheapest alternative is. 

Unfortunately, STDs have become so rampant because the younger generation isn’t aware of … how badly they were impacting members of our society who contracted HIV. Even though we now maintain and control HIV and people live normal lives, it’s still important for us to make sure that if we can prevent anyone from getting it, that we do so, [and] that we’re containing costs [and] lowering costs. And we’re making sure that future health care complications aren’t exacerbated because of contraction of HIV. So that’s just a few things.”

SM: What health-related work have you been doing in the interim?

AN: “Some of these bills end up becoming two year bills … My HIV-related bill I’ve been working on since my first term in office, and I’m in my fifth term now. The first one was to make sure that there was a study done … and we found out that 1.7% of people going into ER rooms between the age range of 14 and 35, are unaware that they are HIV positive. So, that tells you how critically vital some of these early preventative steps and measures are. That bill unfortunately was held in the Senate. And so we are going to try to make sure that it advances forward because at this point, we’ve worked out a lot of the issues with the opposition. There’s no opposition anymore.

Sometimes during the interim, you utilize these opportunities to work through and negotiate a lot of things. AB 1278 [is] something that I’ve been working on during the interim … A lot of the neurodegenerative disease-related issues last year [I was working on] … The [database was] set up almost 20 years ago, back in 2003 or 2004, but it was never funded so it was never collecting data. 

In 2015, working with some researchers at UCLA, I said why not fund this program so that we can start collecting data. The initial $3 million funding gathered hundreds of thousands of dollars … which then triggered more request funding. So now we’ve done another $8 million this last year and we’re going to continue building on funding for these programs … The more we find out about neurodegenerative [diseases], the more we can address the issues that are impacting it, and how we can either help cure or help manage the disease so that it becomes more cost effective in the future. 

One other item that I’ve been working on that has long-term health impacts, but is not in the health care space, is [about] nutritious meals. I had two bills that allowed for plant-based meals to be offered in public schools as an option for children to utilize. The second was a breakfast for toddler program that was fully reimbursable by the federal government. Both of those bills did not advance last year, but we’re working on it so that they advance this year in one bill form.”

SM: How will you continue to fight for increasing accessibility to prescription drugs and reducing Rx costs?

AN: “Part of the challenge is that the industries have gotten so large, whether it’s insurance, whether it’s the medical providers, whether it’s pharmaceuticals, [that] what you hear is constant skirmishes or fights between the three, and then there’s the fourth component, the hospitals themselves. And so you always hear about fights … the issue kind of gets lost in between, and we’re still paying a higher cost. But when you are able to break it down and separate the issues, you realize where certain cost drivers are. 

Sometimes [this is done] by taking a small step forward The real-time pharmacy issue, for example, has a significant impact in lowering costs because it allows you, as the consumer, to know exactly what price you’re going to pay when you go to a pharmacy instead of the times when you do you have a prescription in hand, you give it to the pharmacist, the pharmacist looks at you and says, ‘Oh, did you know that there’s the generic brand of this, and it’s only $10 versus this other medication that would force you to pay $150?’

And you say, ‘Well, sure, that sounds great,’ but you can’t make that decision right then and there because you don’t want to make that decision if your doctor has specifically prescribed you the name-brand [medication]. These are the things that happen on a daily basis. We’ve got to … [help] people make quicker decisions so that they are empowered in real-time and are able to save money in real-time and move forward quickly.

Something like the real-time pharmacy, we already have the technology, we already have the capability. It’s just a matter of implementing it now for everyone’s use. So things like this, can play a significant dent in lowering overall industry-wide costs.. And then and then continue on, you know, again, so much of all of these also is preventative as well making sure that we’re taking the right steps to prevent issues from developing and becoming long-term care costs.

We know that the pharmaceuticals manufacture drugs, and then the consumers utilize them and the pharmacies are the ones that sell the product. But no one knew that somewhere in that chain is the [pharmacy benefit managers (PBMs)]. The pharmacy benefit management companies are the ones responsible for negotiating drug prices on behalf of insurance companies. 

Because it was unregulated, there were a lot of things that started happening that weren’t necessarily to the benefit or advantage of the consumer. What would happen was the pharmaceuticals started selling the product for less. But insurance companies started setting up PBMs as part of their own consortium to negotiate lowering the price. Meanwhile, their price wasn’t necessarily being lowered down. So they were ending up making more money. 

So when you see how the construct of some of these things work, you’re trying to address the specific factors that are contributing to these inequities. So I’m going to continue working on these fronts of the issues, because these are the things that ultimately end up [making health care] unmanageably expensive. I mean, in California, we’re talking about a $380 billion expenditure on health care on an annual basis. And that’s pre-pandemic numbers. You can just imagine what the pandemic has increased our health care costs by.” 

This interview was edited for clarity and length.