WASHINGTON — Lowering prescription drug prices is popular on both sides of the congressional aisle, but the idea of allowing the Health and Human Services (HHS) secretary to negotiate prices for prescription drugs brought up familiar partisan differences at a House Energy & Commerce Health Subcommittee hearing.
“As a provider, I think it’s up to medical professionals and families and patients to work through these situations” that involve figuring out the best treatment, said Larry Bucshon, MD (R-Ind.). “One of my big concerns is if the federal government gets more into this space, you will indeed have financial decisions … that may well limit access, based on the government’s perceived value of your individual life.”
But subcommittee chair Anna Eshoo (D-Calif.) liked the idea, noting that similar things have been done before. “Who here has not supported the VA’s ability to directly negotiate drug prices?” she said.
Subcommittee members were discussing H.R. 3, a bill proposed by House Speaker Nancy Pelosi (D-Calif.) that, in addition to allowing the secretary to negotiate prices for certain drugs, sets the negotiated price at an upper limit of 120% of the volume-weighted average price of six countries (Australia, Canada, France, Germany, Japan, and the U.K.). The bill would also establish a mandatory rebate for drug manufacturers of all drugs covered under Medicare Part B and Part D that increase their prices faster than inflation, and would cap out-of-pocket costs at $2,000 for Medicare beneficiaries enrolled in the Part D drug coverage program.
Rep. John Shimkus (R-Ill.), who recently announced he would not seek re-election, said that he was concerned about the availability of drugs under such a system. “We are really concerned about the government creating a formulary.” Eshoo tried to reassure her Republican colleagues about that issue. “There are no formularies in H.R. 3,” she said. “Medicare will continue to cover all the drugs it does today.”
The witnesses at the hearing provided varying perspectives on the subject. Robert Fowler, PhD, a retired religion professor at Baldwin-Wallace University, in Berea, Ohio, explained that as a multiple myeloma patient, his disease had been well-controlled for a decade with lenalidomide (Revlimid), a drug made by Celgene that retails for $200,000 a year. Before he retired, he was paying $45 per month for the drug under the university’s health plan, but once he retired, his cost for that same medication under Medicare jumped to $12,500 per year, or a little over $1,000 per month.
“Generic drugmakers were supposed to lower the price of [my drug] but Celgene has stopped at nothing to extend its monopoly,” he said. “We as taxpayers must have a mechanism to push back. Patients like me need immediate congressional action.”
Benedic Ippolito, PhD, a research fellow at the American Enterprise Institute, a right-leaning think tank here, gave H.R. 3 mixed reviews. The bill’s changes to Medicare’s Part D program, including the cap on out-of-pocket costs “are exactly the kinds of policy changes that should be encouraged,” he said. However, “I am less enthusiastic about allowing the secretary of HHS to negotiate drug prices … This kind of centralized rate regulation is both challenging and consequential” and has a direct impact on drugmakers’ decisions about investing in research on new drugs, Ippolito added.
Gerard Anderson, PhD, of Johns Hopkins University, in Baltimore, pushed back on the idea that lowering drug prices in the U.S. will cause prices to go up in other countries. “That assumes that drug companies can raise prices in other countries whenever they want; I don’t think they can do this,” he said. It also assumes that the mechanisms available to other countries to keep prices low will go away; “I don’t think so,” he added.
As to the argument that price negotiation will affect drug company decisions on research, most drug research begins in academia and at places like the National Institutes of Health, and then is later purchased by drug companies, he noted.
Subcommittee Republicans complained several times during the hearing about how their ideas were ignored when the bill was being formulated. Previous bills on the topic have involved bipartisan discussions, but “this hearing seems to have come at us fairly quickly on a bill released last week, and it does seem to be a partisan exercise, and that’s unfortunate,” said Rep. Michael Burgess, MD (R-Texas).
“We have worked in a bipartisan way up until now,” said Rep. Greg Walden (R-Ore.), ranking member of the full House Energy & Commerce Committee. “Congress needs to work together with President Trump. He wants to sign a bill … This is partisan politics at its worst, and it’s an avoidable failure.”
Eshoo said she wanted H.R. 3 “to be a bipartisan bill, because I want legislation to become law. H.R. 3 includes many provisions that President Trump and other Republicans publicly supported … and it shares provisions with [Republican Sen. Chuck] Grassley’s drug pricing bill, including capping out-of-pocket costs for seniors and limiting price hikes to [the rate of] inflation.”
Source: MedicalNewsToday.com
