The state's recent decision to postpone what would have been seriously harmful changes to the prescription drug plans for state and county workers ("Public worker drug plan change put off" by Advertiser reporter Greg Wiles), was wise, but does not go far enough.

That's because putting off the decision to move toward "referenced-based pricing" until Jan. 1 simply postpones what could prove to be a fatal blow to protecting the health of thousands of men and women and their families in the state.

Under the proposed new program, patients must switch to lower-cost alternatives in three categories of drugs, get a doctor's exception to stay within their current prescription, or pay substantially more to stay with their old drug.

While these changes might sound benign on the surface, upon closer inspection reference-based pricing has proven to be a more costly, less transparent approach to prescribing drugs that can lead to patients sacrificing their own health, being forced to pick a chemically different, cheaper drug because they can't afford the brand drug they really need.

Reference-based pricing is a little-known practice that is used in Canada to steer consumers away from brand-name drugs and encourage them to use cheaper generic-drugs within the same class. Under reference-based pricing, certain classes of drugs are targeted and patients remaining on a drug that has been effective for treating their condition when a cheaper, chemically-different generic drug is available are charged a much higher price.

Typically, this cost represents the difference between the price of the two drugs, plus the co-payment. In contrast, without reference-based pricing, people buying a brand-name drug where there is no generic equivalent are charged just a co-payment. In some cases, patients might have to pay nearly the full cost of their brand-name medications.

Here in Hawai'i, one of the commonly-used drugs included in the three categories that would be affected by the proposed switch is Lipitor. Because there is no generic option for this highly effective drug, this is just one example where the average state worker could end up paying significantly more each year for this prescription, an expense most local families simply cannot afford. The current Lipitor co-pay is $15 a month. Under referenced-based pricing, the co-pay for Lipitor 10 mg will go up to $62 a month, and for Lipitor 20 mg and 40 mg the co-pay will go up to $90 a month, a $75 difference.

But there are other "hidden" costs associated with referenced-based pricing that must be considered. For example, if a patient decides to switch from Lipitor to the generic drug, Simvastatin, the doctor will typically order several lab tests and require that patient to come in for multiple office visits to ensure the new drug is working effectively and not causing any harm. If it is determined that the patient cannot tolerate the generic Simvastatin and has to go back on Lipitor, this lengthy and expensive process repeats itself. In short, reference-based pricing is many times a more expensive approach to health care. More importantly, it rarely leads to better patient health.

As pharmacists, we have a unique perspective into Hawai'i's health care system. Can we find ways to trim costs? Certainly. Can we operate more efficiently? Without question. But, we cannot — and must not — try to slash health care costs at the expense of people's lives by forcing them to use a less effective drug simply because the correct medication was beyond their personal financial reach.

The sounder, wiser strategy is to prohibit reference-based pricing in Hawai'i. Our state deserves better.