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.

Senate Health Bill Vote Expected Next Week

Published in Woonsocket Call on June 25, 2017

The long-awaited Senate health bill text crafted by a group of 13 GOP senators (all male) appointed by Senate Majority Leader Mitch McConnell of Kentucky to replace and repeal President Obama’s Affordable Care Act of 2017 (ACA), popularly, called Obamacare, was unveiled days ago. Republican lawmakers have worked for over seven years to dismantle the Democratic president’s landmark health care law. Supporters say that ACA brought health care coverage to an estimated 20 million Americans, covered between marketplace, Medicaid expansion, young adults staying on their parent’s plan, and other coverage provisions. Critics charge that Obamacare imposed too many costs to business owners.

Minority Leader Chuck Schumer and Senate Democrats lashed out at GOP Senate leadership charging that the Senate health bill, titled “Better Care Reconciliation Act of 2017,” was written behind closed doors without a single committee hearing being held or draft bill text being circulated to the public. Some Republican senators also expressed frustration for not seeing the details of the GOP bill before its release on June 22, 2017.

Like Senate Democrats, Health and Human Secretary Tom Price was left in the dark, too. At a Senate hearing before the release of the Senate bill the Trump Administration’s top health official stated that he had not seen any legislative language.

Senate Health Bill “Meaner” than House Version

Despite President Trump’s campaign pledge not to touch popular entitlement programs, like Medicare and Medicaid, he strongly endorsed the House Republican passed health bill, the American Health Care Act of 2017 (AHCA). At the eleventh hour, Trump twisted the arms of reluctant GOOP House members to gain their support of the controversial health care bill. Celebrating the passage of AHCA at the White House Rose garden, the president told the attending Republican lawmakers and guests that the GOP health bill was a “great plan,” adding that it was “very, very, incredibly well-crafted.” It was reported weeks later, after a closed-door luncheon with 15 Republican Senators, Trump had called AHCA “mean” and urged the attending Senators make their legislative proposal “more generous.”

With the release of the Senate health bill, Senate Minority Leader Schumer called the bill “meaner” than the House passed version, stressing its negative impact was far worse than AHCA. Trump called the House health bill “mean.” Schumer views the Senate’s version “meaner.”

GOP Senate leadership is pressing for a floor vote before the upcoming July 4th Congressional recess. To meet this deadline, this vote must take place by the end of next week, either Thursday or Friday, after 20 hours of debate. Early next week the Congressional Budget Office will release its score, detailing cost and coverage impact, on the Senate health bill. Moderate Republican senators might just be influenced not to vote for the bill if reduces health coverage for millions of Americans.

It usually takes 60 votes to pass a bill in the Senate. But, GOP Senate leadership is using a technical parliamentary procedure, referred to as reconciliation, to allow the Senate health bill to pass with only 50 votes, including the Vice President as a tiebreaker.

At press time, there are four conservative senators (Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin) and one moderate senator (Dean Heller of Nevada)., who have publicly expressed their opposition to the Senate health bill. With all Democratic and Independent senators in their caucus opposing passage of the bill, GOP Senate leadership can only afford the defection of two Republican senators if they want their bill to pass.

Meanwhile, a 100-year old organization, Planned Parenthood, is gearing up to fight a provision of the Senate health bill that would cut $555 million in funding. Two moderate GOP Senators, Susan Collins of Maine and Lisa Murkowski of Alaska, are on the fence voting for the bill if cuts are made to Planned Parenthood.

Aging Groups See Writing on Wall if Senate Passes Health Bill

The released 142-page GOP Senate health bill, written hastily behind closed doors, will overhaul the nation’s health care system, impacting on one-sixth of the nation’s economy. Dozens of aging, health care and medical groups, including AARP, National Committee to Preserve Social Security and Medicare (NCPSSM), the American Medical Association, and the American Hospital Association, are voicing their strong opposition to the GOP Senate’s health care fix.

And this list keeps growing as next week’s Senate vote approaches.

The Washington, DC-based AARP, representing a whopping 38 million members, vows to hold GOP Senators accountable for a bill that hurts older Americans. The nonprofit group charges that “the legislation imposes an “Age Tax” on older adults – increasing health care premiums and reducing tax credits [that made insurance more affordable under Obamacare], makes cuts to both Medicaid funding, and yet gives billions of dollars in take breaks to drug and insurance companies.”

“AARP is also deeply concerned that the Senate bill cuts Medicaid funding that would strip health coverage from millions of low-income and vulnerable Americans who depend on the coverage, including 17 million poor seniors and children and adults with disabilities. The proposed Medicaid cuts would leave millions, including our most vulnerable seniors, at risk of losing the care they need and erode seniors’ ability to live in their homes and communities,” says
AARP Executive Vice President Nancy LeaMond, in a statement.

“The Senate bill also cuts funding for Medicare which weakens the programs ability to pay benefits and leaves the door wide open to benefit cuts and Medicare vouchers. AARP has long opposed proposals that cut benefits or weaken Medicare, adds LeaMond.

LeaMond says, “As we did with all 435 Members of the House of Representatives, AARP will also hold all 100 Senators accountable for their votes on this harmful health care bill. Our members care deeply about their health care and have told us repeatedly that they want to know where their elected officials stand. We strongly urge the Senate to reject this bill.”

Another Washington-DC based organization, the National Committee to Preserve Social Security and Medicare, an advocacy group whose mission is to protect Social Security and Medicare, issued a stinging statement criticizing the Senate health bill.

“The Senate’s version of AHCA is an exercise in political expediency that does nothing to safeguard access to quality healthcare for older Americans. President Trump rightly called the House-passed bill ‘mean’ and lacking ‘heart.’ Unfortunately, the Senate bill is only marginally less mean in some ways, and even more heartless in others, says Max Richtman, President & CEO of the National Committee to Preserve Social Security and Medicare.

Adds, Richtman, “The Senate health bill is “a lose-lose for seniors and the American people. The biggest loss is that the AHCA ends the Medicaid program as we know it. Astoundingly, the Senate bill makes even deeper cuts to Medicaid than the House did. This is devastating news for today’s and tomorrow’s seniors suffering from Alzheimer’s, cancer, the after-effects of stroke and other serious conditions who depend on Medicaid to pay for long-term care. Millions will lose Medicaid coverage over the next ten years.”

“Despite some tweaks to premium subsidies, the Senate legislation will make healthcare unaffordable for many near seniors aged 50-64. The legislation allows insurers to charge older Americans five times as much as younger adults. Though the Senate bill nominally protects people with pre-existing conditions, the waiver of essential benefits means older patients with pre-existing conditions like diabetes, cancer, and heart disease will pay sky-high premiums [making these premiums unaffordable to most]. Finally, the bill weakens Medicare by reducing the solvency of the Part A Trust fund,” notes Richtman.

Looking at a Crystal Ball

Darrell M. West, vice president and director of Governance Studies at the Washington, D.C.-based the Brookings Institution, says that the Senate health bill does not fix the issues critics had with the House version. “It moves Medicaid from an entitlement to a discretionary program. It uses a longer phase-in period than the House, but imposes deeper cuts on the program. This is very problematic from the standpoint of poor and disabled people who need help,” says West.

According to West, Republican Senators from more moderate states already have said they will not support the current version. There also are conservative Senators who feel the bill does not go far enough in repealing Obamacare. If those positions hold up, it doesn’t look like the bill will pass.

West warns those who oppose the passage of the Senate health bill to not underestimate Senate Majority Leader Mitch McConnell. “He is willing to negotiate with individual Senators to get their votes so it is premature to call the bill dead. McConnell knows the Senate well and understands what compromises need to be made to get to 50 votes,” notes West.

If Senate Republicans pass their health care bill next week, I predict they might just find out that they have “awakened a sleeping giant,” the Democrats. When the dust settles after the 2018 mid-term elections we will find this out.