The Political Challenge of Reining in Drug Prices
The high price of prescription drugs is an issue of great concern to most Americans and has even attracted the attention of presidential candidates from both parties. Although the growth rate was slower than in the previous year, prescription drug prices continue to outpace price growth for other health care sectors. It’s no wonder then that CMS is taking action to try to reduce drug spending. But strong pushback from the drug industry, among others, illustrates why tackling high drug prices remains such a challenge.
The current proposal takes aim at a perverse incentive in Medicare Part B that pays physicians a percentage of the cost of a drug they administer in their office. As a result, reimbursement is much higher for higher cost drugs. But the proposal started drawing fire before it was even unveiled. Opponents have mischaracterized the proposal as interfering with clinical decision making, but in reality it does nothing of the sort. It is merely designed to remove the financial incentive to administer more expensive drugs. However, many physician groups and patient support groups have joined PhRMA in opposition. It will be interesting to see whether CMS stays the course or whether the general but diffuse societal interest in lower drug prices will be trumped (can I still use that word?) by the intense interest of those who are most closely affected.
Someone is Not Paying Attention
The pattern of the Medicaid debate has remained consistent pretty much all year long and this week was no exception. On the one hand, efforts to close the coverage gap in states that have not done so continue to be blocked, typically by a small number of very conservative legislative leaders, even while the majority of the public wants to move forward. This week we saw polls in both Utah and Kansas showing public support, but legislative leaders in those states are refusing to move forward. On the other hand, states that have closed the gap are realizing the benefits and are unwilling to move backward. We saw this in Arkansas where pro-coverage lawmakers in the Republican party voted to continue the state’s “private option” expansion and in New Hampshire, where a bill to retain full Medicaid coverage received overwhelming support from the Republican-controlled House.
In a break from its normal partisan gridlock, the Senate yesterday passed legislation to step up efforts to treat drug addiction by an almost unanimous vote. Even an effort to add $600 million in new funding, while ultimately unsuccessful, enjoyed some bipartisan support. The legislation includes a variety of provisions to reduce overdose deaths, help veterans and improve prevention efforts at the local level.
Even though Donald Trump’s health care plan is essentially just a rehash of typical Republican talking points the “plan” (such as it is) drew harsh criticism from Republican health policy analysts, largely for its lack of coherence. Notwithstanding some of the candidate’s statements, there is also no indication of how he would address issues such as pre-existing condition exclusions or what would become of the 20 million people who have gained coverage thanks to the ACA.
Finally, an amusing tidbit courtesy of fivethirtyeight. Ted Cruz is the only candidate for whom “will repeal every word of Obamacare” falls within his top 20 phrases, occurring more often than “if I’m elected President.”