Drug pricing debate going into hibernation

(This story previously appeared in The Hill Extra.)

A legislative push to address high drug prices may have slowed for the moment, but healthcare providers expect the debate will resume next year when lawmakers reauthorize medical product user fees.

Price increases of high profile medications gained attention from members of Congress, who have hosted a series of congressional hearings over the last year to unravel the complex drug pricing system.

But now, after the elections, “it’s all gone very quiet, and that’s not a good sign,” Ceci Connolly, president of the Alliance of Community Health Plans, said during a panel discussion on drug pricing, hosted by Politico Pro and CVS Health. “I suspect the issue of high drug prices is clinging to the very edge of the table right now in Washington.” 

Lawmakers’ attentions have been diverted to a host of other issues that President-elect Donald Trump has brought to the forefront, such as trade, tax reform, immigration and a massive infrastructure project, Connolly said.

Another new challenge might be getting industry and federal officials to cooperate with congressional inquiries. For example, the Senate Judiciary Committee postponed a hearing this week on a settlement agreement between EpiPen maker Mylan, which has been the subject of several hearings, after everyone called to testify refused to attend. Chairman Chuck Grassley (R-Iowa) said he would consider compelling their participation.

The focus on drug pricing is expected to return next year when Congress considers four bills to reauthorize user fees that fund the Food and Drug Administration’s review of drugs and medical devices.

Connolly said policy discussions that will likely surround those reauthorization vehicles may not answer some of the big questions, such as how Medicare negotiates its drug prices or how manufacturers calculate cost, but it could affect how the FDA operates and how quickly generics come to market.

“Washington loves a vehicle,” she said.

Road ahead.

One of the drug pricing proposals (S. 3335, H.R. 6043) floated would require drug manufacturers to submit a report 30 days before they increase the price of certain drugs by 10 percent or more in a 12-month period. The report would include manufacturing, research and development costs for the drug, net profits, and marketing and advertising spending.

Generic Pharmaceutical Association President Chip Davis balked at the legislation, saying it should account for the differences between brand name and generic drugmakers. 

Manufacturers work within a commoditized market, controlled largely by wholesalers, and generally don’t know 30 days in advance if they are going to increase prices, he said. The bill would impose fines on drugmakers who don’t provide notification, which Davis said could cause smaller companies to stop making products, reducing competition. 

Discussions around drug pricing transparency often center around how companies price their products and what the money is used for, but Peter Bach, director of health policy and outcomes at Memorial Sloan Kettering Cancer Center, said providers and patients would also like more information when they’re discussing treatment options.

A doctor will prescribe a pharmaceutical without knowing whether the patient can afford it, he said.

“If we are stuck with high deductible plans and a lot of patient exposure to cost sharing, we still need tools at the point of care to signal to doctors and patients how much they will pay when they get their prescription,” he said.

People, not price.

Pharmacists are also advocating for a greater role in helping patients navigate costly drug choices.

CVS Health executive vice president Tom Moriarty said pharmacists help drive medication adherence, noting that $300 billion in unnecessary hospitalizations and other costs would be saved if people simply take their prescribed medications. 

“All too often we tend to discuss the issue in the context of people needing more medication, but Americans actually taking their medications as prescribed is one of the most effective ways to cut costs in the system,” he said.

Moriarty said simplifying complex drug treatment regimens for patients through outreach can halve the number of patients readmitted to the hospital, and he called for policies that empower pharmacists to provide patient care. 

The National Community Pharmacists Association has highlighted bipartisan proposals that would allow state-licensed pharmacists to receive compensation for certain patient care services under Medicare Part B (S. 314, H.R. 592) and let patients in underserved areas use the pharmacy of their choice if it accepts the drug plan’s terms and conditions (S. 1190, H.R. 793). 

“[Pharmacists] are uniquely positioned to recognize and close gaps in care that would otherwise lead to wasteful or unnecessary spending,” Moriarty said.