Senate committee hears update on Nevada Drug Transparency Program; staff urge streamlining

The Nevada Senate Committee on Health and Human Services heard a presentation on the Drug Transparency Program from Keiko Duncan, pharmacy director at the Division of Healthcare Financing and Policy. The program collects price and justification data from manufacturers and other entities and publishes reports intended to help lawmakers and consumers.

Duncan summarized the program's history and current operations. She said the law tracing to 2017 began with an essential diabetes drug list, was expanded and adjusted in subsequent sessions, and now uses a threshold-based list for drugs that cost more than $40 per course of therapy and experience a ‘‘significant price increase,’’ a term defined in Nevada Revised Statutes by comparison to the Consumer Price Index. She told the committee the program currently has two contract employees (a pharmacist and a management analyst) who compile the incoming data and produce public reports.

Duncan showed that the program’s first data collection year was 2018 and that penalties collected peaked in 2019 at about $1,000,000 assessed against 18 manufacturers. In the most recent one-to-two year period she cited, penalty collections had dropped to roughly $50,000–$60,000 and involved only one or two manufacturers; she said no manufacturer has been fined twice. The 2023 Drug Transparency Report (calendar-year 2023 data published in June 2024) showed incremental decreases in insulin prices over the prior three years but also that roughly 9 percent of drugs billed to Medicaid experienced a significant price increase in 2023, with an average increase of about 13.4 percent for those drugs.

Manufacturers supply free‑form justifications for price increases; program staff group those justifications for public reporting. Duncan told the committee the three most common rationale categories were general inflation, research and development, and marketplace dynamics; other reasons cited by manufacturers included profit, marketing and patient assistance programs.

Duncan suggested several program changes for committee consideration: removing the separate essential-diabetes drug list to avoid duplicative reporting, clarifying pharmacy benefit manager and wholesaler reporting so identical data are not filed twice, and identifying sustainable funding for ongoing operations because penalty revenues have declined. She said the program is considering whether the statutory lists and overlap in required reports could be simplified while retaining information useful to policymakers and the public.

Committee members thanked Duncan for the briefing and asked follow-up questions about whether lower‑cost generics below the $40 threshold could experience large percentage increases; Duncan said those drugs are tracked if and when they breach the threshold and that such a dynamic can be a valid policy concern.