House Committee Moves to Rein in Skyrocketing Prescription Drug Costs

Published in the Woonsocket Call on December 1, 2019

On Nov. 18, House Antitrust Subcommittee Chair David N. Cicilline (D-RI) and Judiciary Committee Chairman Jerrold Nadler (D-RI) introduced The Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 (H.R. 5133) to put the brakes on skyrocketing prescription drug costs. The bill attacked increasing costs by prohibiting pharmaceutical companies from engaging in anticompetitive “product hopping.”

Two days later, the Committee unanimously passed the bipartisan bill to drive down the rising costs of prescription drugs. Now H.R. 5133 goes to the House floor for a vote.

“Big pharmaceutical companies have done everything they can to increase their profits regardless of who it affects. Their CEOs make millions in bonuses ever year while hardworking folks are forced to ration their medicine just so they can put food on the table for their kids,” said Cicilline, in a released statement announcing the introduction of the bill.

Since becoming Chair of the House Antitrust Subcommittee, Cicilline has sought to take on the anticompetitive behavior in the health care and pharmaceutical sectors. “This is wrong, and it needs to stop. This bill, along with the suite of legislation to lower health care costs the House has passed already this year, will put an end to anticompetitive behavior that is driving prices up while pushing the middle class further and further down,” says Cicilline in pushing for the bill’s passage.

“This bill builds on the Committee’s strong record of bipartisan legislation to confront one of the leading drivers of high prescription drug costs—efforts by drug companies to keep generic drugs off the market so that they can preserve their monopoly profits,” adds Chairman Nadler when H.R. 5133 was thrown into the legislative hopper. “The outrageous behavior of product hopping puts profits before patients and thwarts the competition that is essential to lowering prescription drug prices,” he charges. Nadler says that H.R. 5133 would “encourage drug companies to focus on delivering meaningful innovation for sick patients rather than delivering profits to their bottom line.”

Fixing the Problem

According to Cicilline and Nadler, pharmaceutical companies use a wide array of tactics when their patent on a drug is near expiration to switch patients to another version of the drug that they have the exclusive right to sell. Called “product hopping,” this anticompetitive practice extends the manufacturer’s ability to charge monopoly prices by blocking the patient’s ability to switch to a cheaper, generic alternative. Product hopping benefits the manufacturer’s bottom line at the expense of patients who are stuck paying higher prices often for many years at a time, they say.

The two Congressmen say that there is another roadblock to lowering prescription drug costs. Although antitrust agencies have made an effort to curb product hopping, the Federal Trade Commission (FTC) still faces a number of hurdles under existing law when trying to hold companies accountable for this anticompetitive conduct. The Affordable Prescriptions for Patients Through Promoting Competition Act of 2019 strengthens the FTC’s ability to bring and win cases against pharmaceutical companies that engage in all forms of product hopping.

A similar version of H.R. 5133 was considered in the Senate and it would save taxpayers an estimated $500 million according to the nonpartisan Congressional Budget Office.

A week earlier, before H.R. 5133 was passed by the and Judiciary Committee, a new report was released by AARP Public Policy Institute (PPI), giving data to Congress to enact legislation to lowering prescription drug costs. The report findings indicate that brand-name drug prices rose more than twice as fast as inflation in 2018.

According to the AARP PPI report, retail prices for 267 brand-name drugs commonly used by older adults surged by an average of 5.8 percent in 2018, more than twice the general inflation rate of 2.4 percent. The annual average cost of therapy for one brand-name drug ballooned to more than $7,200 in 2018, up from nearly $1,900 in 2006.

“There seems to be no end to these relentless brand-name drug price increases,” said Debra Whitman, Executive Vice President and Chief Public Policy Officer at AARP, in a Nov. 13 statement announcing the release of the report. “To put this into perspective: If gasoline prices had grown at the same rate as these widely-used brand-name drugs over the past 12 years, gas would cost $8.34 per gallon at the pump today. Imagine how outraged Americans would be if they were forced to pay those kinds of prices,” says Whitman.

Brand-name drug price increases have consistently and substantially exceeded the general inflation rate of other consumer goods for over a decade, notes the AARP PPI data.

If brand-name drug retail price changes had been limited to the general inflation rate between 2006 and 2018, the average annual cost of therapy for one brand-name drug would be a whopping $5,000 lower today ($2,178 vs. $7,202). The report’s findings note that the average senior takes 4 to 5 medications each month, and the current cost of therapy translates into an annual cost of more than $32,000, almost 25 percent higher than the median annual income of $26,200 for a Medicare beneficiary.

“While some people will undoubtedly see a slower rate of price increases as a sign of improvement, the reality is that there is absolutely nothing to stop drug companies from reverting back to double-digit percentage price increases every year,” said Leigh Purvis, Director of Health Services Research, AARP Public Policy Institute, and co-author of the report. “Americans will remain at the mercy of drug manufacturers’ pricing behavior until Congress takes major legislative action,” adds Purvis.

With over 340 days before the upcoming 2020 Presidential and Congressional elections, Senate Democrats say that more than 250 House-passed bills are “buried in Senate Majority Leader Mitch McConnell’s (R-Ky) legislative graveyard.” The Senate’s top Republican}, referred to as the “Grim Reaper,” has blocked consideration on these bills (including prescription drug pricing bills) effectively killing them. As the election day gets closer this number is expected to increase.

President Trump and Republican lawmakers are loudly chanting that the Democrats are “getting nothing done in Congress.” This is just fake “political” news. Major reforms that would prop up Social Security, Medicare, and lower Prescription Drug prices get the legislative kibosh in the GOP-controlled Senate. It is now time to put these bills to an up or down vote in the upper chamber. The voters will send a message to Congress next November if they agree with the results. It’s time for McConnell to put down his reaper

For details, of AARP report, go to http://www.aarp.org/rxpricewatch.

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

Uncompensated Cost of Caregivers is a Whopping $470 Billion

Published in the Woonsocket Call on November 17, 2019

Approximately 41 million unpaid family caregivers provided an estimated 34 billion hours of care in 2017 — worth a whopping $470 billion — to their parents, spouses, partners, and friends, according to the latest report in AARP’s Valuing the Invaluable series. The 2019 estimated value of family caregiving is based on 41 million caregivers providing an average of 16 hours of care per week, at an average value of $13.81 per hour. Previous AARP Public Policy reports were released in 2006, 2008, 2011 and 2015.

“It’s encouraging to see greater recognition of the emotional, physical and financial struggles that caregivers face,” said Susan Reinhard, senior vice president, AARP Public Policy Institute, in an April 14th statement announcing the release of the 32-page report. “But the demands on family caregivers are not just a family issue and we must continue to push for meaningful support and solutions,” says Reinhard.

Every caregiver, as well as their families, know the value of their efforts,” said AARP Rhode Island State Director Kathleen Connell. “In Rhode Island, the estimated total value of 114 million hours of work by the state’s 136,000 caregivers is $1.8 billion. The aggregate is astounding, making a clear case for supporting this vital commitment made by family and loved ones.”

“These numbers inspire our members who spend many hours at the State House as AARP Rhode Island advocacy volunteers,” Connell added. “They have helped pass key legislation — the CARE Act, paid caregiver leaves and many other key bills — that have given caregivers resources and opportunities to make their task less daunting. Caregivers are truly invaluable,” she says.

Putting a Spotlight on the Nation’s Caregivers

AARP’s report notes that the estimated $470 billion equates to about $1,450 for every person in the United States (325 million people in 2017). Its economic impact is more than all out-of-pocket spending on US health care in 2017 ($366 billion). Uncompensated care provided by caregivers is also three times as much as total Medicaid spending on long-term services (LTSS) and supports ($154 billion in 2016) and even the total spending from all sources of paid LTSS, including post-acute care ($366 billion in 2016).

The AARP researchers say that the estimate of $470 billion in economic value of uncompensated care is consistent with nearly two decades of prior research studies, all of which found (like the current study) that the value of unpaid family care vastly exceeds the value of paid home care.

The AARP report, Valuing the Invaluable: 2019 Update Charting a Path Forward, also explores the growing scope and complexity of caregiving, including an aging population, more family caregivers in the paid workforce, and the increasing amount of medical and nursing tasks entering the home.

According to the AARP report, family care givers, who provide day-to-day supports and services and manage complex care tasks, are becoming more diverse. While most family caregivers are women, about 40 percent are men who are providing more assistance than just driving to doctor’s appointments and grocery stores or paying bills. Like all caregivers, they are assisting a parent, spouse or friend with bathing and dressing, pain management, managing medication, changing dressings, helping with incontinence and even preparing special diets.

While a majority of baby boomers are providing caregiving services, a growing number of younger adults are now shouldering this responsibility, too. Nearly 1 in 4 (24 percent) are millennials (born between 1980 and 1996). Despite their low salaries, the young adults are spending more of their salary on caregiving expenses than other generations. The researchers estimated that this spending in 2016 was about 27 percent of their income.

About 60 percent of family caregivers are juggling a job and providing care, too. This will continue as aging baby boomers choose to remain in the labor force to bring additional income into their household. Workplace benefits for caregivers becomes become even more important as they face economic and financial strain in their later years.

For those employees who choose to leave their job to become a full-time caregiver, they risk both short-and long-term financial difficulties, say the researchers.

Finally, the researcher’s recommendations to better support family caregivers included developing a robust and comprehensive national strategy with the needs of an increasingly diverse caregiver population included; providing financial relief and expanding workplace policies; developing caregiver training programs; and expanding state and federal funding for respite programs.

More Work Needs to Be Done

The AARP report warns that the rising demand for caregivers with the graying of the nation’s population, shrinking families will drastically reduce the supply. In 2010, there were 7.1 potential family caregivers for every person age 80 and over. By 2030, there may be only 4.1 potential caregivers for every person age 80 and over, they say.

Although significant federal and state policy are already in place to assist the nation’s caregivers, more work needs to be done, say the researchers. They call on Congress and state lawmakers to keep pace with the changing demographic, social trends and needs of the family caregiver.

Resources and information on family caregiving, including AARP’s Prepare to Care
Guides, are available at http://www.aarp.org/caregiving.

AOA Reauthorization in the Senate’s Hand

Published in Woonsocket Call on November 10, 2019

Last month, after a 40-minute debate, the House moved to pass H.R. 4334, The Dignity in Aging Act of 2019, a bipartisan reauthorization of the Older Americans Act (OAA) that provides funding for a wide range of popular local and state programs. These programs make sure seniors have access to food thru Meals on Wheels, transportation, part-time job opportunities to support financial security and to combat social isolation and other basic services they need to live independently and with dignity.

Introduced on Sept. 16 by Rep. Suzanne Bonamici (D-OR), who chairs the House Education and Labor Committee’s Subcommittee on Civil Rights and Human Services which has jurisdiction of AOA, and 25 cosponsors (eleven Democrats and fourteen Republicans, the House Committee on Education and Labor reported out a marked-up 68 page bill on Oct. 28, and a motion to suspend the rules and pass the bill as amended was agreed to by a voice vote on the House floor that day. The bipartisan bill would reauthorize $12.5 billion through 2024 for AOA programs assisting seniors.

Although the Houses passes a bill to reauthorize the OAA, the Act expired at the end of the fiscal year on Sept. 30. With bipartisan support it is expected that the reauthorization will move through both chambers as quickly as possible. Until then, OAA programs will continue to operate, and funding will flow either through enactment of continuing resolutions (CRs) or final FY appropriations legislation.

The Nuts and Bolts

Specifically, the House passed AOA reauthorization bill establishes a National Research, Demonstration, and Evaluation Center for the Aging Network in the Office of the Assistant Secretary of HHS. It would create an initiative to coordinate federal resources to promote the independence and safety of adults living at home as they age. The legislation would also provide tailored support to family caregivers who play a vital role in helping again Americans maintain their independence. It also puts a stronger focus on addressing social isolation among seniors by empowering local organizations to test local solutions.

On the day of the floor vote, over 70 aging and health care groups including AARP, Meals on Wheels, the Medicare Rights Center, and National Association of Area Agencies on Aging, wrote to House Speaker Nancy Pelosi and Ranking Member Bobby Scott, urging the House to swiftly advance H.R. 4334 to reauthorize the AOA because the current reauthorization of the Act expired September 30, 2019.

The OAA, initially passed in 1965 with Medicare, Medicaid, along with landmark civil rights laws, as part of President Lyndon B. Johnson’s Great Society initiative. OAA currently serves roughly 11 million older Americans, including 3 million older Americans who regularly rely on this federal program to meet their basic needs. The law provides funding to each state based on its share of the nation’s older adults.

The population of Americans age 60 and over has grown more than 60 percent since 2001, but OAA funding has only grown by roughly 20 percent. In 2010, OAA funding was $42.95 per senior in today’s dollars. Today it is $27.25 per senior. According to the Government Accountability Accounting Office, as a result, 83 percent of low-income older Americans who experience food insecurity do not receive any meal services through OAA. The same report found that two-thirds of older Americans who struggle with daily activities received limited or no homebased care services.

Most important, The Dignity in Aging Act includes an inflation-adjusted 7 percent increase in funding for OAA programs in the first year, followed by a 6 percent increase in each of the four years that follow. This results in more than a 35 percent total increase in program funding over the five-year reauthorization period, boosting OAA funding above its historical high watermark in FY2010.

Calls for AOA Reauthorization

“Aging Americans have supported our communities throughout their lives – now it is our turn to care for them,” said Bonamici. “I’m proud that the House passed my bipartisan Dignity in Aging Act, which will provide seniors and their caregivers with desperately needed resources and expanded services,” says the lawmaker who was first elected to Congress in 2012.

“I have heard and read too many stories about seniors rationing medication or saving portions of their meals so that they can stretch their resources just a bit further into the week,” Bonamici said on the House floor. “… This bill provides a rare bipartisan opportunity to help millions of older Americans across the country spend less of their limited income on costly care and, just as importantly, to empower every individual to age with dignity.”

I look forward to working with my colleagues in the Senate so this legislation can swiftly be signed into law,” says Bonamici, who also played a key role in the last reauthorization of OAA in 2016.

After passage of H.R. 4334, Rep. David N. Cicilline (D-RI) said, “After a lifetime of working hard and playing by the rules, Rhode Island seniors should never have to worry about making ends meet. I was proud to support the bipartisan Dignity in Aging Act to help ensure all seniors can retire with dignity and economic security. The Senate should take this bill up without delay.”

According to Cicilline, “In FY18, Rhode Island received $7,013,999 through the Older Americans Act. These funds are used to provide Meals and Nutrition Services, Supportive Services and Preventive Health, and the National Family Caregiver Support Program. This reauthorization will mean that older Rhode Islanders will continue to receive these services,” says the Rhode Island Congressman who serves as co-chair of the House Democratic Policy and Communications Committee

The Washington, D.C.-based AARP also applauded the passage of H.R. 4334. In a statement, AARP Senior vice president Bill Sweeney said, “The Dignity in Aging Act addresses AARP’s family caregiving priorities, including further strengthening support for family caregivers, extending the RAISE Family Caregivers Act, and providing increased funding levels for OAA programs. OAA programs provide services like home-delivered meals, transportation, medical appointments, protection from elder abuse, and job training.”

Sweeney says, “an estimated 40 million family caregivers provide a staggering $470 billion annually in unpaid care to their loved ones—ranging from bathing and dressing to paying bills and transportation and assisting with complex medical/nursing tasks. By supporting family caregivers, we can help people live independently in their own homes, helping to delay or prevent more costly nursing home care and unnecessary hospitalizations.”
Sweeney urges Congress to reauthorize OAA by the end of the year to help ensure the sustainability of OAA programs.”

A Final Note

Now the action of reauthorizing AOA moves to the Senate where a bill has not been formally introduced. But Senators Susan Collins (R-ME) and Bob Casey (D-PA) the chairman and ranking member of the Senate Special Committee on Aging are working on a reauthorization bill, says Richard Luchette, Communications Director for Rep. David N. Cicilline. With Senate Majority Leader Mitch McConnell (R-Kentucky) systematically blocking Senate voting on House passed legislation, Luchette urges the McConnell to take up the House bill so that seniors will be provided the services they rely on.