Opinion
SB 41 threatens to increase prescription drug costs
Image by Vitalii Petrushenko. Capitol Weekly welcomes Opinions on California public policy or politics. Click here for more information about submitting an Op-Ed.
OPINION – For my family, pharmacy is more than a profession—it’s a legacy. My uncle was the first to become a licensed pharmacist, and since then, my brother, sister-in-law, husband, and I have proudly followed in his footsteps. Today, I serve as a pharmacist at CVS Specialty in Redlands, California, where I work closely with patients living with hemophilia—a rare bleeding disorder—and their care teams to ensure timely access to lifesaving medications.
That kind of high-quality access is now at risk. The California Department of Finance has officially opposed Senate Bill 41, citing a California Department of Justice warning that its implementation costs would be “significant and unquantifiable.” When the state’s own fiscal experts flag a proposal this strongly, Governor Newsom should pause—especially when patient care could be disrupted.
Specialty drugs for conditions like hemophilia, cancer, and autoimmune diseases can cost hundreds of thousands of dollars per month. That’s why pharmacy benefit managers (PBMs) are essential. They negotiate discounts, manage formularies, and help keep prescription costs affordable for patients and the plans that cover them.
Specialty drugs that support patients with complex conditions, like hemophilia, cancer, and autoimmune diseases, among others, can cost hundreds of thousands of dollars per month. That is why pharmacy benefit managers (PBMs) are so critical.
By acting as a central resource connecting the various parts of the healthcare system, PBMs help pharmacists like me foster a seamless patient experience – at times, I am able to enroll a new member, get expedited prior authorization approval, and ship medication all in the same day. For patients discharged from the hospital, their medication can be waiting at home, ready to begin treatment without delay.
In California alone, CVS Caremark manages pharmacy benefits for millions of residents and partners with hundreds of public and private sector employers and labor unions. These partnerships help ensure that even patients with complex conditions like hemophilia have continued access to the medications they rely on every day.
Earlier this year, California enacted a law increasing transparency across the drug supply chain – legislation I fully support. But Senate Bill 41 proposes to impose additional, untested regulations before the current law has had time to be implemented or evaluated. SB 41 would restrict the negotiation tools PBMs use to lower drug costs, potentially increasing financial burdens on small businesses, unions, and patients.
As a pharmacist on the front lines of care, I worry these changes will make it harder for patients to stay on the therapies they need. Many already face significant barriers – adding uncertainty around coverage or cost only deepens the challenge.
SB 41 echoes a bill Governor Newsom vetoed last year, citing concerns that it would limit access to lower-cost prescription options. Lawmakers should allow the current reforms time to take effect and let data guide future policy decisions – not rush into additional regulations that might backfire.
Colleagues at CVS Caremark consistently go above and beyond to work with us to ensure their members receive the medications they need. I’ve seen firsthand how PBMs help their members, our patients, in critical moments. I recall one patient – let us call her Olivia – who had been with our pharmacy for years – called one weekend to share that her newborn granddaughter was experiencing a bleed resembling hemophilia and needed assistance getting her treatment. Despite the distance and the challenges, CVS Caremark connected Olivia and her family with a hemophilia treatment center in Colorado and coordinated care to ensure the newborn promptly received the necessary treatment.
The most rewarding element of my work has always been supporting patients and their families. A few years ago, when my father was diagnosed with cancer, his pharmacist played a vital role in his care and comfort during an extremely difficult time for our family. I am honored to pay it forward every day by playing that same role for my patients like Olivia and their families.
I urge Governor Newsom: remain consistent on this issue and veto SB 41. This bill may be well-intentioned, but its consequences will be felt by the very people it aims to protect. Let the current reforms take effect. Evaluate their impact. And above all, protect the tools that allow pharmacists like me to deliver care efficiently and compassionately.
Californians battling rare and serious diseases deserve better than uncertainty and higher costs.
Pooja Vasani is a CVS Specialty Pharmacist in Redlands.
Want to see more stories like this? Sign up for The Roundup, the free daily newsletter about California politics from the editors of Capitol Weekly. Stay up to date on the news you need to know.
Sign up below, then look for a confirmation email in your inbox.
While PBMs’ intended role was to negotiate lower drug prices, any lower prices that have been negotiated have been pocketed by those PBMs, and any savings that might have occurred have not been passed onto employers or to individual patients. PBMs often behave like insurers but are not regulated as such. They’ve enjoyed having very little oversight at the state or federal level since their inception. And the more powerful PBMs have continued to gain more power. The 3 largest PBMs manage more than 80% of all prescriptions filled in the US and leverage that power to actually increase costs for employers and patients, who in spite of having insurance, often find that their cost share is higher with insurance than without. Additionally, PBMs exact ever-increasing fees onto pharmacies, which has resulted in the closure of many independently owned pharmacies and even on larger chain stores, thus greatly diminishing patient access to medications and pharmacist services.
Senate Bill 41 helps protect patients, local business owners, and anyone who has ever overpaid for their medications. The bill will introduce transparency measures regarding PBMs’ fees and ban their ability to force patients into using affiliated pharmacies. It also bans spread pricing, where certain PBMs charge more for a medication than what they pay a pharmacy for the same medication.
Transparency and affordability go hand-in-hand. Holding PBMs accountable with SB 41 helps ensure Californians can access the life-saving medications they need.