Time for Congress to revisit Pharma’s broken deal?
This past Tuesday, PhRMA was before Congress. Not lobbying to block price negotiations or generic competitors, but attending a hearing in their honor (click here for details of the hearing). Chairman Henry Waxman, of the House Energy and Commerce Committee, has called upon PhRMA to explain their recent price increases exposed by AARP mid-November in its Rx Watchdog Report.
At Tuesday’s hearing, Rep. Waxman put the price increase in perspective. He said:
Our nation is trying to recover from the largest economic downturn since the Great Depression. The Consumer Price Index has actually dropped over the last year. Social Security checks will remain stagnant. Millions of Americans have lost their jobs and their health insurance.
Yet, the brand-name prescription drug industry raised prices by more than 9% over the last year.
Rep. Waxman also noted that the health reform bill passed by the House last month will both provide insurance coverage to “36 million citizens who would otherwise be without it” but he cautioned legislators must not “write the pharmaceutical industry a blank check as we reform the health care system.”
Rep. Waxman also praised the approach under the House bill:
The House health care reform bill strikes an important balance that puts consumers and taxpayers first. In return for the billions of dollars in new market opportunities, we require that the drug industry provide additional discounts for the Medicaid program. And we end the multi-billion dollar windfall that the industry received when dual-eligible enrollees were switched from Medicaid to Medicare Part D drug coverage.
The House bill uses the money raised from these industry concessions to help millions of Americans afford health care coverage and to close the Part D donut hole.
At the hearing, Kathleen Stoll, Deputy Executive Director, Director of Health Policy at Families USA, testified that: “In recent years, Americans have spent a significantly larger amount on prescription drugs. In fact, total spending on prescription drugs in the United States nearly doubled between 2000 and 2007, rising from $120.6 billion to $227.5 billion.”
Ms. Stoll praised the House health care reform bill, noting that it would improve access to prescription drugs by requiring coverage for drugs in all health plans sold in the individual market, and by eliminating annual and lifetime caps on benefits, and capping out-of-pocket costs.
The chair of the board of AARP, Bonnie Cramer, also testified about the effect of rising drug prices on AARP members, seniors, and other consumers. She noted the costly impact of rising drug prices on government spending for subsidized seniors under Medicare Part D, and for seniors or others on Medicare Part B. Her testimony noted that the specialty, or biologic drugs covered under Part B are the biggest current drug cost. for the program’s entire $17 billion spend on drugs in 2007.
The top six biologics represented $7 billion of the total [$17 billion in Part B drug costs in 2007], or 43 percent of all Part B drug spending. To put this in context, Medicare Part B spending for one biologic drug – Epoetin alfa – in 2007 ($2.6 billion) was greater than FDA’s , with over 10,000 employees, entire FY2008 budget (2.3 billion).
Ms. Cramer also voiced concerns for the “millions of Americans … that fall into the donut hole each year.” And she noted that the number of part D plans charging 33% co-insurance for the very high priced specialty drugs has risen from only four of the nearly national plans to “more than half” of the Part D plans today. This means that drug price increases are felt directly by the patient. Ms. Cramer put this in perspective as follows:
… rheumatoid arthritis medicines such as Enbrel and Humira averaged $1,633 per prescription in 2008. The average cost of a multiple sclerosis drug was $2,006. At 33 percent coinsurance, enrollees cost would exceed $500 per prescription. Most patients with either of these conditions filled at least eight such prescriptions in 2008.
The AARP report revealed the shocking price increase of 9.3 % for brand-name drugs, 10.3% for specialty drugs. This is contrasted to the 7.8% decrease in the price of generic drugs during the same 12-month period ending September 30, 2009. The report notes that all but one of the top 25 selling brand name drugs used by Medicare Part D plans rose from between 4.8% and 19.7%, and all but two of the top 25 specialty drugs also rose in cost, some by as much as 28.2%. Ten of these best-selling specialty drugs rose by more than 12%. This is happening at a time when the economic recession had driven the prices of most other goods and services down.
The New York Times covered the reports release, and noted that the drug industry’s own major consulting firm, IMS Health, reversed their earlier market prediction of a 1% declines in sales for 2009, and now predicts a 4.5% growth in drug sales. This means $21 billion in added drug costs in 2009, a windfall profit for the industry as the rest of the country grapples with record unemployment and ongoing recession.
Impacts of the price increase: The new price increases have reversed the trend and produced two results — an immediate profit increase for 2009-2010; and a significantly higher base price for their future revenues once the approximately 30 million newly insured customers are added through the passage of health reform. Drug companies set the price for the drugs they sell, and can raise or lower them at any time. Additionally, the companies offer rebates and other discounts based on their price to different insurers, state Medicaid agencies and federal agencies. The higher the base price, the more leverage for the drug company in negotiating with purchasers. The result of this market manipulation is an approximately $120 Billion profit.
PhRMA appears to have gone back on their deal by changing the prices so radically and shifting an $80 Billion loss into a $120 Billion profit-grab. PhRMA has been one of the most vocal supporters of health reform—they should be given that they have literally billions to gain if the law passes. Drug industry ads in support of reform, rather than in opposition, have been a welcomed on Capitol hill. But the good will PhRMA generated supporting reform may have been shaken by the recent price increase.
This profiteering has caught the attention of Congress. The House Energy and Commerce’s subcommittee on Health is investigating this price increase, presumably with an eye towards strengthening the drug cost containment measures in the health reform bill. Up until now, many drug cost containment initiatives have been off-limits due to the ‘PhRMA deal’. PhRMA made a deal with President Obama and some Congressional leaders last Spring that was to provide $80 billion in drug savings over the next 10 years, mainly through discounts to brand name drugs in the Medicare D doughnut hole.. In exchange, they would support health reform. One of the biggest potential areas for savings that was declared off-limits by industry is the ability for Medicare to negotiate drug prices.
Even Senator Baucus, who chairs the Senate Finance Committee, and brokered the deal with Pharma on behalf of the Senate, has said that the total amount in future saving legislators will require from Pharma is “still in discussion.”
Tuesday’s Congressional hearings may help influence the current Senate debate, and the negotiations in the conference process (which would reconcile the differences between the legislation passed by the House and any future Senate bill.) We hope our Congressional leaders will see the stark reality exposed by the AARP Watchdog Report – that Pharma’s control of drug prices makes their proffered discounts illusory and holds us all hostage to their profiteering.