Rising drug prices put more pressure on Congress to act; advocates are optimistic, but drug makers are a powerful lobby

By Trudy Lieberman

Community Health News Service

Maybe – just maybe – Americans will get some relief from the relentlessly rising prices of pharmaceuticals.

That, of course, depends on Congress pushing back against the drug companies’ formidable lobbying machine, their generous campaign contributions, and the industry’s historical coziness with members of Congress. But this year seems different.
When you consider that the country’s spending on prescription drugs increased by 28 percent from 2011 to 2016, it’s easy to see why it’s harder for politicians to ignore the public anger over prices of life-saving medicines they can’t afford.

Iowa Sen. Charles Grassley, who heads the Senate Finance Committee and has co-sponsored a bipartisan bill to tackle drug prices, has said that passing a bill to control them will be essential to Republicans’ “keeping a majority in the Senate” in the 2020 elections. “Eventually it will come down to this. There are 22 Republicans up for election this year, and if it’s like in my state … there is a great deal of disgust with the rapidly increasing prices of drugs.”

Is a breakthrough really at hand?

I checked in with David Mitchell, a former public relations executive and now a cancer patient, who has been leading a grassroots effort to challenge congressional thinking about drug prices. His organization, Patients for Affordable Drugs, has heard from some 20,000 patients recounting the troubles they’ve had paying for their medicines. Many have told their stories to Congress.

Mitchell was upbeat. “The fact we’ve gotten this far, and there’s still talk of getting something meaningful done is remarkable,” he said. “The anger is really boiling up, and elected officials know and feel this anger can cost them their jobs if they don’t do something.”

He said the question is: Can a compromise be reached that will get to the president’s desk?

Drug legislation is never easy to understand, so I asked Mitchell to break down the main ideas for reform and the points of contention. Here are the main elements that could be in a final package.

Changing patent laws would encourage market competition and make it easier for generics and biosimilar drugs – similar versions of medicines made from living microorganisms found in plant or animal cells – to come to market.

Negotiating drug prices for Medicare beneficiaries would be a huge step toward helping seniors. The 2003 law that authorized Medicare’s drug benefit prohibits Medicare from negotiating prices with pharmaceutical manufacturers. A bill sponsored by House Speaker Nancy Pelosi would allow Medicare to negotiate prices for the top 250 brand name drugs that are usually the most expensive and would levy steep fines for manufacturers that refuse to negotiate.

Capping out-of-pocket costs for seniors might encounter the least opposition from the industry, and Pelosi’s bill would limit those costs to $2,000 a year. A Senate bill introduced by Grassley and Oregon Sen. Ron Wyden caps expenses at $3,100. “Everyone agrees that we need to fix the unlimited out-of-pocket expense under Medicare,” Mitchell says.

Pricing drugs more in line with other industrialized countries, using a system called reference pricing, is far more controversial. U.S. drug prices are two to three times higher than those in most other nations, and a reference pricing system would cut costs for patients and revenue for drug makers, which argue that their profits drive research that gives the U.S. the world’s best drugs.

More transparency for pharmacy benefit managers, the middlemen between insurers and drug manufacturers, who cut secret rebate deals that determine what patients ultimately pay, would shine a light on how prices get set.

As Congress considers what to do, the drug industry is taking no chances that things might change. Although a recent Gallup poll shows drug companies are the most poorly regarded businesses in a list of 25 industries, their public-relations machine is in overdrive trying to convince Congress to preserve their customary path to profits. An epic legislative battle is in the making.

How do you think drug prices should be controlled? Write to Trudy at trudy.lieberman@gmail.com.

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