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.

2050 and the Caregiver Dilemma

Published in the Woonsocket Call on April 22, 2018

The year 2030 marks an important demographic turning point in U.S. history according to the U.S. Census Bureau’s 2017 National Population Projections, released last month. By 2030, older people are projected to outnumber children. In the next twenty years, when these aging baby boomers enter their 80s, who will provide informal caregiving to them.

Almost three years earlier, in a July 2015 report, “Valuing the Invaluable: 2015 Update Undeniable Progress, but Big Gaps Remain,” the AARP Public Policy Institute warned that fewer family members will be around to assist older people with caregiving needs.

According to AARP’s 25-page report, coauthored by Susan C. Reinhard, Lynn Friss Feinberg, Rita Choula, and Ari Houser, the ratio of potential family caregivers to the growing number of older people has already begun a steep decline. In 2010, there were 7.2 potential family caregivers for every person age 80 and older. By 2030, that ratio will fall sharply to 4 to 1, and is projected to drop further to 3 to 1 in 2050.

Family caregivers assisting relatives or close friends afflicted with chronic, disabling, or serious illness, to carry out daily activities (such as bathing or dressing, preparing meals, administering medications, driving to doctor visits, and paying bills), are key to keeping these individuals in their homes and out of costly nursing facilities. What is the impact on care of aging baby boomers when family caregivers no longer provide assistance in daily activities?

“In 2013, about 40 million family caregivers in the United States provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013, up from an estimated $450 billion in 2009,” notes AARP’s caregiver report. What will be the impact on the nation’s health care system without family caregivers providing informal care?

The Census Bureau’s 2017 National Population Projections, again puts the spot light on the decreasing caregiver ratio over the next decades identified by the AARP Policy Institute, one that must be planned for and addressed by Congress, federal and state policy makers.

Who Will Take Care of Aging Baby Boomers?

With the expansion in the size of the older population, 1 in every 5 United States residents will be retirement age. Who will provide informal caregiving in our nation with a larger adult population and less children to serve as caregivers?

“The aging of baby boomers means that within just a couple decades, older people are projected to outnumber children for the first time in U.S. history,” said Jonathan Vespa, a demographer with the U.S. Census Bureau. “By 2035, there will be 78.0 million people 65 years and older compared to 76.4 million under the age of 18.”

The 2030s are projected to be a transformative decade for the U.S. population, says the 2017 statistical projections – the population is expected to grow at a slower pace, age considerably and become more racially and ethnically diverse. The nation’s median age is expected to grow from age 38 today to age 43 by 2060.

The Census Bureau also observed that that as the population ages, the ratio of older adults to working-age adults, also known as the old-age dependency ratio, is projected to rise. By 2020, there will be about three-and-a-half working-age adults for every retirement-age person. By 2060, that ratio will fall to just two-and-a-half working-age adults for every retirement-age person.

Real Challenges Face Congress as the Nation Ages

Jean Accius, Ph.D., AARP Policy Institute’s Vice President, Independent Living, Long-Term Services and Supports, says, “The recent Census report highlights the sense of urgency to develop innovative solutions that will support our growing older adult population at a time when there will likely be fewer family caregivers available to help. The challenges that face us are real, but they are not insurmountable. In fact, this is an opportunity if we begin now to lay the foundation for a better system of family support for the future. The enactment of the RAISE (Recognize, Assist, Include, Support and Engage) Family Caregivers Act, which would create a strategy for supporting family caregivers, is a great path forward.”

Max Richtman, President and CEO of the Washington, DC-based National Committee to Preserve Social Security and Medicare, gives his take on the Census Bureau’s 2017 statistical projections, too.

“Despite how cataclysmic this may sound, the rising number of older people due to the aging of baby boomers is no surprise and has been predicted for many years. This is why the Social Security system was changed in 1983 to prepare for this eventuality. Under current law, full benefits will continue to be paid through 2034 and we are confident that Congress will make the necessary changes, such as raising the wage cap, to ensure that full benefits continue to be made well into the future,” says Richtman.

Richtman calls informal caregiving “a critical part of a care plan” that enhances an older person’s well-being. “While there currently are programs such as the Medicaid Waiver that will pay family members who provide caregiving support more can be done to incentivize caregiving so that loss of personal income and Social Security work credits are not barriers to enlisting the help of younger individuals to provide informal support services,” he says.

Adds Richtman, the Medicare and Medicaid benefits which reimburse for the home-based services and skilled nursing care “will be unduly strained ”as the diagnosed cases of Alzheimer’s disease skyrockets with the growing boomer population. He calls on Congress to “immediately provide adequate research funding to the National Institutes of Health to accelerate finding a cure in order to save these programs and lower the burdens on family caregivers and the healthcare system. “

Finally, AARP Rhode Island State Director Kathleen Connell, says “Our aging population represents challenges on many, many fronts, including healthcare, housing, Social Security, Medicare and, of course, caregiving. It would be nice to think everything would take care of itself if there were more younger people than older people. But that misses the point entirely. The needs of older Americans are a challenge to all Americans, if for no other reason than most of us end up with multiple late in life needs. And too many reach that point without savings to cover those needs.”

“It’s worth noting, by the way, that many of the solutions will come from people 50 and older — many of whom will work longer in their lives to improve the lives of older Americans. We need to stop looking through the lens of ‘old people’ being the problem and instead encourage and empower older Americans to take greater control over their lives as they help others,” says Connell.

“Congress needs to focus on common sense solutions to assure families that Social Security and Medicare are protected. The healthcare industry needs to face the medical challenges. And at the state and local level, we must focus on home and community-based health services,” adds Connell.

For details about the Census Bureau’s 2017 statistical projections, co to http://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html.

For more information about AARP’s July 2015 caregiver report, go to http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf.

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Senate Republicans Pushing to Vote on Latest Health Care Proposal

Published in the Woonsocket Call on September 24, 2017

With the September 30 expiration of its special Senate budget reconciliations status that allows the chamber to repeal and replace Obamacare with just a simple majority, Senate Republicains are rushing to bring their latest health care fix up for vote by the end of next week. The GOP’s last attempt failed by a razor thin margin.

Critics charge that the Senate Republicans push to quickly vote on their latest health care bill, crafted by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, comes before the issuance of a complete analysis of the Congressional Budget Office (CB)) that would detail the legislative proposal would impact coverage nationwide.

AARP, the National Committee to Preserve Social Security and health care provider groups say that Graham-Cassidy’s fix to put the brakes to rising health care costs will increase premium and out-of-pocket costs for millions. They say that the nonpartisan CBO would give the details to its negative impact.

Even Gov. Chris Christie came out opposing the GOP health care over haul bill that Senate Republicans are pushing. “I can’t support a bill that takes $3.9 billion away from the people of the state of New Jersey,” said the New Jersey Governor, reported last Wednesday by the Trentonian News. Democratic Colorado Gov. John Hickenlooper and Gov. Republican Governor John Kasich, of Ohio, held a bipartisan news conference this week calling for a bipartisan approach to reforming health care.

Talk Show Host Jimmy Kimmel also came out swinging against the Graham-Cassidy proposal, calling Sen. Cassidy, a co-sponsor of the bill, a liar. Earlier this year the Republican Senator had appeared on his show and after hearing that Kimmel had an infant son with a heart condition, he assure Kimmel that any GOP proposal would protect those with pre-existing conditions. It does not, at least to Kimmel’s satisfaction.

For days, aging and provider groups and even Democrats on cable shows expressed concern that the Graham-Cassidy Bill would allow states to permit insurance companies to charge people with preexisting conditions (an estimated 25 million Americans age 50 to 64) just because they have cancer, diabetes, high blood pressure, asthma, etc.

Age Tax Hits Seniors Right in their Wallets

On September 20, 2017, AARP writer Dena Bunis, charges in a blog posting, “Latest Senate Health Care Bill Revives Age Tax for Older Americans,” the GOP’s latest effort to repeal President Obama’s landmark Affordable Care Act (ACA), imposes an “age tax” on older Americans by eliminating premium tax credits and cost sharing payments that helped low-income persons afford deductibles and copayments for medical services.

The Graham-Cassidy bill would also allow states to get federal waivers for insurers to charge older Americans more so as to lower the cost for younger policyholders. The ACA limits the expense for older policyholders at three times the amount younger ones pay, says Bunis.

To illustrate the “age tax” Bunis, citing an AARP analysis, notes, that for a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year. If that 60-year-old lives in a state that allows insurers to charge older individuals dramatically higher premiums, he or she would face an additional $4,124 increase in premiums,” she says.

The Graham-Cassidy bill takes away the premium tax credits that help older adults pay for their health care coverage, notes Bunis. . “About 6 million 50- to 64-year-olds buy their health coverage in the individual market, and about half of those individuals receive tax credits to help pay their premiums, she says, citing an analysis by the AARP Public Policy Institute.

The Graham-Cassidy bill would also eliminate vital cost-sharing payments that help low-income persons — especially those over age 50 — afford deductibles and copayments for medical services, too, adds Bunis, noting that “about 58 percent of adults enrolled in ACA marketplace plans get cost-sharing assistance, and 35 percent of those individuals are between 50 and 64 years old.”

Bunis notes that the latest Senate health care proposal would shift federal funds to the state through block grants that would allow each state to develop their own specific health care coverage initiatives to reduce costs. But, she says that Medicaid per capita cap or block grants funding proposals, “fundamentally change the Medicaid program [covering 17.4 million older Americans and people with disabilities], which has been a safety net for millions of poor Americans and people with disabilities.

Receiving Medicaid eligibility for coverage and services would leave fewer doctors and other providers willing to take Medicaid patients or provide needed care because reimbursement is too low.

Block grants, mandated by the Graham-Cassidy bill, would only last through 2026, offering no replacement health care plan, says Bunis. “Over 20 years, Graham-Cassidy would slash Medicaid funding by $1.2 trillion to $3.2 trillion, turning control of the program to the states and shifting costs over time to states and Medicaid enrollees,” she says.

“Americans have a right to know how this bill would impact them. Regretfully, the Majority Leadership is rushing the Senate to blindly consider Graham-Cassidy without fully vetting this proposal in committee hearings and mark-up, where amendments could be considered, and without a full Congressional Budget Office (CBO) score. CBO previously estimated that repeal-without-replace would cause 32 million people to lose health coverage,” said Max Richtman, President and Chief Executive Officer of the National Committee to Preserve Social Security and Medicare (NCPSSM), in a statement to Senate Finance. The Senate panel is scheduled to hold a hearing on the Graham-Cassidy bill next week.

“Senate consideration of any bill that would change the accessibility and affordability of essential health care for millions of Americans without a complete CBO analysis and committee debate would be the height of legislative malpractice,” says Richtman.

NCPSSM calls the latest GOP Senate Health care proposal “deeply flawed” and suggests that it be referred to the Senate Committee on Health, Education, Labor and Pensions where Chairman Lamar Alexander and Ranking Member Patty Murray are attempting to hammer out a bipartisan solution to strengthen the ACA’s individual health insurance market reforms.

A Final Take

A press time, Republican Sens. Ron Paul (Kentucky) and John McCain (Arizona) give thumbs down to the Graham-Cassidy bill with the Portland Press Herald reporting that Sen. Susan Collins of Maine, saying “I’m leaning against the bill.” Fifty Republican Senators must give their thumbs up, with Vice President Mike Pence casting the tie-breaking vote, to get a simple majority for passage. Now, the votes are just not there for passage.

But, one long-time Republican Senator speaks honestly on the record why President Donald Trump his fellow Senate caucus members are pushing so hard for passage of the latest Senate health care proposal. “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Iowa Republican Senator Chuck Grassley. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Sadly, if true the Republican-controlled Congress has put millions of Americans at risk of losing their health care coverage and at risk for the sake of a political promise. Our lawmakers must become statesmen and vote on legislative proposals because it is the right thing to do, not politicians who vote by party-line.