The fate of a bill to force pharmaceutical companies to disclose insulin data, register sales representatives and ultimately divulge their funding of patient organizations rested with Republican Gov. Brian Sandoval on Thursday.
The Democratic-controlled Legislature gave final approval to legislation that would put Nevada at the forefront of a national movement to rein in soaring prescription drug prices.
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It focuses on making public the sticker prices, profits and middlemen surrounding insulin sold in Nevada. America's three insulin manufacturers would face fines of $5,000 each day they fail to provide the data without explanation.
The proposed regulations are rivaled only by a recent law in Vermont asking drugmakers to justify certain price increases of 15 percent or more.
For two years, California legislators have been debating requiring drugmakers to give advance notice of price increases. The Nevada bill would mandate that pharmaceutical companies notify the state 90 days before making any changes to insulin prices.
Bill sponsor Sen. Yvanna Cancela, a Las Vegas Democrat, and supporters say transparency could prompt manufacturers to lower prices, and would allow diabetes patients to push back against their increasing costs at the pharmacy counter.
Drugmakers have come out in force against Senate Bill 265, primarily arguing that drug pricing and economics are much more complex than bill supporters claim and the regulations could ultimately backfire on patients.
Some Republican lawmakers echoed concerns about unintended market ramifications, including insulin shortages, before the Assembly's party-line 26-14 vote on Thursday.
"We are disappointed that the Nevada Assembly voted to put forth legislation that will do nothing to help patients afford their medicine," said Priscilla VanderVeer, spokeswoman for lobbying juggernaut Pharmaceutical Research and Manufacturers of America.
About one in every 11 Nevada residents had diabetes in 2014, similar to the national average that year, according to the Centers for Disease Control and Prevention.
A Las Vegas union of resort and casino workers behind the bill initially tailored it to medications that treat diabetes because the widespread condition represents one-fifth of the group's prescription drug costs. Representatives of Culinary Union 226 and the group's health plan also said they thought it could make the measure politically palatable for business-friendly lawmakers and the Republican governor.
The focus on insulin struck a chord nationally and has received an outpouring of support from patients as well as people who lost loved ones to diabetes across the country.
Seven Republican state senators voted for it last week.
In addition to the insulin-specific rules, all drugmakers would have to register sales representatives who market their prescription drugs in Nevada.
The proposal would also mandate that certain nonprofit organizations report donations from pharmaceutical companies, insurance companies or the middlemen who negotiate prices, called pharmacy benefit managers.