Note: A version of this article by our editor is co-published today in the Health and Human Rights Journal.
Antavia Worsham of Cincinnati died because she could not afford the insulin to treat her Type 1 diabetes. David Bridges of Indiana is forced to ration his glaucoma medicine. John Krane put off filling the prescription for a $159,000 medicine to treat his brain tumor.
Chances are, you know of similar stories. Each year, one in five Americans skip doses or fail to fill prescriptions because of cost. Medicines are priced as high as $750,000 per patient, and costs for many drugs have doubled or even tripled in recent years. A post-election Harvard poll showed that both Republicans and Democrats cited drug pricing as the top priority for this new Congress.
When public outrage builds, politicians scramble to respond. That is especially true of the many ambitious folks looking at a 2020 run for President, most of whom have rolled out proposals to lower prescription drug prices. The Venn diagram of overlapping priorities for the President, the Republican-controlled Senate and the Democrat-controlled House is not a large area—but it does include reducing the price of prescription drugs.
All of that sound and fury does not necessarily translate to big changes. The pharmaceutical industry is reliably at the top of the spending lists for both political campaign donations and hiring lobbyists, and they are desperately deploying all of those dollars to defend the windfall profit status quo. But popular pressure is building, and politicians would rather lose campaign contributions than elections.
Plans to fix our prescription drug pricing crisis can be confusing. The confusion is caused in part by obscure issues of patent law and government regulation, and in part by pharmaceutical corporations intentionally keeping their costs and pricing processes secretive. So Faith in Healthcare's editor, who has written extensively on drug pricing reforms, cuts through the fog to provide you with this quick ranking of the major proposals to lower drug prices:
FOUR STARS: Take Away Drug Patents if Prices are Too High. Senator Bernie Sanders and Rep. Ro Khanna’s Prescription Drug Price Relief Act takes aim at the very heart of the drug pricing crisis: the government-granted monopolies (usually on medicines discovered with government-funded research) that allow pharma corporations to price medicines produced for a few dollars at a markup of 1,000 times or more.
The plan here is to bypass patent protections to allow generic competition on medicines that are “excessively priced,” usually meaning that the U.S. price is higher than the average price in similar countries like Canada, the U.K. and Japan. This Vox article has more details.
THREE STARS: Allow Medicare to Negotiate the Cost of Medicines It Purchases. One of the biggest reasons why Americans pay the highest drug prices in the world is that we are the only country that prohibits our government from using its purchasing clout to negotiate down prices. (Did I mention Pharma has a powerful lobby?) Unshackling the Medicare Part D program’s negotiating power has broad popularity outside of the halls of Congress—92% of Americans support it and President Trump campaigned on it. It is the subject of bipartisan support, including a bill by Rep. Lloyd Doggett and Sen. Sherrod Brown. But Trump has backed away from that campaign promise, and it may take a Senate power shift to see this happen.
THREE STARS: Allow the Government to Make Some Medicines. The Affordable Drug Manufacturing Act sponsored by Senator Elizabeth Warren and Rep. Jan Schakowsky would create an Office of Drug Manufacturing. The new agency would respond when there are failures in the hoped-for competitive market for generic drugs, such as when there are too few companies competing.
Generic medicine costs are usually not the biggest problem. But this proposal earns three starts for pushing forward a solution that bypasses for-profit systems and for specifically targeting insulin, where three manufacturers have raised their prices in lock step for decades. As explained in this STAT article, the government could support additional manufacturers or even start making the medicines ourselves.
TWO STARS: State-Level Action. State governments’ obligations for Medicaid and the cost of healthcare for state employees and prisoners means their budgets are forced to accommodate more than $20 billion a year for prescription drugs. According to the National Academy of State Health Policy, 28 states passed 45 laws last year aimed at curbing drug prices.
States are pushing for transparency in corporations’ decisions on price-setting, reducing the cut taken by middlemen pharmacy benefit managers, and importation of medicines from countries where prices are far lower. Real change has to happen at the federal level. But sunshine is the best disinfectant and importation underscores the rigged nature of U.S. drug pricing, so transparency and allowing imports all helps build momentum and organizing power at local levels.
TWO STARS: Block Unjustified Price Increases. The CURE High Drug Prices Act, introduced by several Senators, including likely presidential candidates Kamala Harris and Amy Klobuchar, would empower the Department of Health and Human Services to review price increases of more than 10% per year. HHS could then order that unjustified prices be lowered and reimbursements be issued to patients. This could help block huge spikes, but 10%/year increases add up quickly, and this does not address the current high prices. More information about the bill is here.
ONE STAR: More Transparency with State Medicaid. In 2017, Senator Cory Booker found himself on the wrong side of the drug pricing backlash after a pro-Pharma vote earned him the ire of Democrat allies and activists. Booker had a quick change of heart, and continues down the path of the converted with the Medicaid Drug Decisions Transparency Act.
The bill would require drug corporations to disclose their payments to all who serve on the boards that decide states’ Medicaid drug coverage. This is well-justified, but not likely to lead to significant, immediate change. The legislation follows a Center for Public Integrity/NPR investigation, and here is NPR’s story on Booker’s bill.
ONE STAR: Lower Medicare Part B Drug Costs/Require Rebate Reform. Medicare Part B covers the often enormously high cost of drugs administered directly by physicians. President Trump, who has said drug companies are “getting away with murder,” has proposed lowering those costs by 30% by comparing the Medicare prices to the cost in other countries. He has also proposed reducing the role of the pharmacy benefit manager “middlemen” in the drug pricing process.
Nothing wrong with that, but blaming the middlemen is the top Big Pharma talking point for a reason. Manufacturers are far and away the most responsible for high drug prices, and the Trump plan lets Big Pharma off the hook.
ONE STAR: Litigation and Investigations. Lawsuits and government investigations in multiple states are focused on alleged price-fixing in prescription drugs, with particular attention to insulin. None have yet yielded a verdict or a significant settlement. They may some day bear fruit, as there is plenty of potentially illegal corporate behavior in the prescription drug world. But the bigger problem is what our U.S. system currently considers as legal—yet is clearly immoral in its impact on the lives of Antavia Worsham, David Bridges, John Kane, and millions of others.
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From one star to four, none of these proposals will single-handedly make prescription drugs suddenly affordable for all. And few stand real chances of passing in the next year or two. There does seem to be some bipartisan Congressional support for less ambitious (think one to two-star range) changes. For example, Senate Finance Committee Chair Sen. Chuck Grassley is on record in support of limiting restrictions on individuals importing cheaper medicines from Canada and removing barriers to generic competitors reaching the market.
But if Americans impacted by prescription drug price-gouging keep raising our voices, more significant change is coming. Especially if people of faith troubled by the immorality of profit-triggered suffering speak out as well.
Faith and Healthcare Notes
- The tragic costs of “prior authorization.” The dreaded process of obtaining “prior authorization” for private insurance coverage of medicines or treatment is more than just frustrating. It can be deadly. A new survey of physicians by the American Medical Association finds one in four reporting that the need to seek prior authorization has led to a serious adverse event such as “death, hospitalization, disability or permanent bodily damage, or other life-threatening event for a patient in their care.”
- Seeking faith groups that endorse single-payer or universal healthcare. In an upcoming issue, Faith in Healthcare will be presenting a summary of faith denominations and organizations that have endorsed a single-payer Medicare for All type healthcare system for the U.S., or at least explicitly called for universal healthcare. If you know of denominations or organizations that have taken that stand, let us know by sending an email to email@example.com
- Debunking the Myths About Medicare for All. From Public Citizen, an in-depth report on Medicare for All—along with a great two-minute video debunking the myths about the plan. Private corporations do not want to lose access to the billions in taxpayer dollars they receive on healthcare now, and it is important to be informed about the truth behind the lobbying and PR campaigns opposing reform.