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Attacking Rising Prescription Drug Costs

Published in the Woonsocket Call on April 7, 2019

The Washington, DC-based AARP timed the release of its latest Rx Price Watch report as the House Energy Commerce Committee marked up and passed a dozen bills just days ago, six that would lower prescription drug costs. The legislative proposals now go to the House floor for consideration.

AARP’s new report, a continuation of a series that has been tracking price changes for widely used prescription drugs since 2004, was circulated to House Committee members before their markup and vote and its findings sent a message to the lawmakers that they hear from their older constituents, that is the costs of pharmaceutical drugs is skyrocketing, making it difficult to fill needed prescriptions.

Poll after poll findings reflect the concerns of seniors about their ability to pay for prescribed medications. According to a Kaiser Family Foundation poll released last month, 79 percent of survey respondents view drug prices to be “unreasonable,” while just 17 percent found the costs to be “reasonable.” Twenty-four percent of these respondents found it difficult to pay the costs of their prescription drugs.

Generic Drugs Can Save Dollars

According to the new AARP Public Policy Institute (PPI) report, by Leigh Purvis and Dr. Stephen W. Schondelmeyer, the average annual cost of therapy for one widely used brand-name prescription drug in 2017 was over 18 times higher than the cost of therapy for one generic drug. The cost for a generic medication used on a chronic basis averaged $365 per year. In contrast, the average annual cost for a brand-name prescription drug was $6,798. But, four years earlier the price differential between these same market baskets was substantially smaller ($4,308 verses $751 respectively).

“Generics account for nearly nine out of every 10 prescriptions filled in the U.S. but represent less than a quarter of the country’s drug spending,” said Debra Whitman, Executive Vice President and Chief Public Policy Officer at AARP, in a statement released with the PPI’s 28 page report “These results highlight the importance of eliminating anticompetitive behavior by brand-name drug companies so that we get more lower-priced generic drugs on the market,” says Whitman.

AARP’s PPI report, entitled “Trends in Retail Prices of Generic Prescription Drugs Widely Used by Older Americans,” found that retail prices for 390 generic prescription drugs commonly used by older adults, including Medicare beneficiaries, decreased by an average of 9.3 percent in 2017, compared to the general inflation rate of 2.1 percent. The decline follows two consecutive years of substantial generic drug price decreases; the previous two consecutive years saw increases in generic drug prices. All but three of the 390 generic prescription drugs analyzed in AARP’s report had a retail price change in 2017. While prices for 297 (76 percent) drug products decreased, 90 (23 percent) products had price increases.
Six commonly used generic drug products had retail price increases of greater than 70 percent, including a nearly 200 percent increase for sertraline HCL, an antidepressant, finds the AARP.

AARP’s PPI report found that with older adults taking an average of 4.5 prescription drugs every month, those using generic prescription drugs were likely to have an average annual retail cost of $1,642 in 2017.

“The gap between average annual brand-name and generic drug prices has increased dramatically—brand name drug prices were six times higher than generic drug prices in 2013 but more than 18 times higher in 2017,” said Leigh Purvis, Director of Health Services Research, AARP Policy Institute, and co-author of the report. “As long as brand name drug prices continue to skyrocket, the value of prohibiting brand name drug company practices that slow or prevent competition from generic and biosimilar drugs cannot be overstated.”

AARP Pushes for Passage of Bills to Lower Drug Costs

Before the Committee on Energy and Commerce vote on April 3, in correspondence AARP urged Chairman Frank Pallone, Jr. (D-N.J.) and Ranking Member Greg Walden (R-Ore) to enact two bills (along with four other proposals) being considered at the morning markup session. These legislative proposals would lower prescription drug costs and had previously been approved by the Energy and Commerce Health Subcommittee.

In the correspondence, AARP’s Nancy A. LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer, pushed for passage of H.R., 1499. the “Protecting Consumer Access to Generic Drugs Act of 2019.” introduced by Rep. Bobby Rush (D-IL). This proposal would make it illegal for brand-name and generic drug manufacturers to enter into agreements in which the brand-name drug manufacturer pays the generic manufacturer to keep a generic equivalent off the market. The bill was passed by voice vote.

LeaMond also supported H.R., 965, the “Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019,” introduced by Reps. David Cicilline (D-RI), Jim Sensenbrenner (R-WI), Jerrold Nadler (D-NY), Doug Collins (R-GA), Peter Welch (D-VT), and David McKinley (R-WV). The proposal would establish a process by which generic manufacturers could obtain sufficient quantities of brand drug samples for testing thereby deterring gaming of safety protocols that brand manufacturers use to delay or impede generic entry. The bill passed by a bipartisan vote of 51-0.

At the markup, Pallone and Walden were able to work out philosophical differences on H.R. 1499 and H.R. 965. The two lawmakers also hammered out a compromise on H.R. 1503, the “Organize Book Transparency Act of 2019,” that would ensure that the Orange book, which identifies drug products approved on the basis of safety and effectiveness by the Food and Drug Administration, is accurate and up-to-date.

Washington Insiders say that Democratic control of the House will ensure the passage of these legislative proposals on the House floor and the bipartisan vote on the CREATES Act in the lower chamber creates an opportunity for Senate Finance Committee Chairman Chuck Grassley (R-Iowa) to successfully push his CREATES Act companion measure in the Senate.

Grassley says the broad, bipartisan action by the House Energy and Commerce Committee to advance the CREATES Act is a major win for consumers. “I look forward to advancing this bill because it will cut down on abuses in the system that keep prices high for patients. I’m also pleased that the committee advanced a bill to address pay-for-delay schemes. Although that bill is not identical to the bill I’ve sponsored in the Senate, the bill’s movement shows that the committee is serious about addressing the pay-for-delay problem,” says the Senator.

As They See It…

AARP’s LeaMond, says “Brand-name drug companies want to stifle generic competition to protect their monopolies and profits. AARP believes that eliminating these deliberate anticompetitive behaviors will result in a more robust generic drug market and greater savings for both patients and taxpayers. The Congressional Budget Office estimated that legislation such as the CREATES Act could save taxpayers more than $3 billion over a decade, and the Federal Trade Commission estimated pay-for-delay deals cost consumers and taxpayers $3.5 billion a year.

“We have long supported the CREATES Act and banning pay-for-delay agreements, and are heartened that Congress is acting to improve access to generic drugs. These bills will promote competition driving down costs for seniors,” says Lisa Swirsky, Senior Policy Analyst, at the National Committee to Preserve Social Security and Medicare.

“Congressman Cicilline has been a leader in our caucus for putting prescription drug prices at the front of our agenda. Moving generics to market faster is an important step to lower prescription drug costs for every American,” said House Speaker Nancy Pelosi. “House Democrats have made it a top priority to lower Americans’ health costs by reducing the price of prescription drugs, and these bipartisan bills show we mean to deliver,” she says.

Midterm Elections are Here: Your Vote Sends a Message to Congress

Published in the Woonsocket Call on November 11, 2018

The mid-term elections are here and Americans have an opportunity, if they choose to vote, to send a strong message to Capitol Hill about what policy issues are important to them. All 435 Congressional seats are on the ballot including 35-Senate seats. The outcome of these political races will ultimately impact older Americans. Will Congressional lawmakers work to ensure the solvency of Social Security and Medicare, or protect those with pre-existing conditions? Or will they put political differences aside to craft legislation that will put the brakes to spiraling prescription drug costs.

Last month, AARP released, a 52-page report, “2018 Mid-Term Election Voter Issue Survey,” that found that the majority of those surveyed say the following issues will help them make their voting decisions in days: lowering health care costs (79 percent), strengthening and reforming Social Security (75 percent) and Medicare, (70 percent) and putting the brakes to skyrocketing prescription drug costs (74 percent).

AARP’s survey data were collected by Alan Newman Research (ANR) between July 7 and July 18, 2018. ANR conducted a total of 802 telephone interviews of registered likely voters age 50 and older. All data were weighted by education, race/ethnicity, age, gender, and census division according to Current Population Survey statistics provided by AARP.

What Issues Are Important to Older Voters?

Let’s take a closer look at AARP’s July telephone survey findings…

The top issue for the Democratic survey respondents was health care costs, Social Security, drug costs and Medicare while Republicans identified national security as their issue.

People become eligible for health insurance through Medicare when they turn age 65. Democrats responding to the AARP survey (77 percent) were more likely to support giving those age 50 to 64, the option to buy health insurance through Medicare than the responding Republicans (57 percent).

Vermont Senator Bernie Sanders and other lawmakers have proposed a national health plan in which all Americans would get their insurance from a single
government plan (called Medicare-for-All). The researchers noted that Democratic respondents gave the thumbs up (75 percent) to supporting this legislative policy while only 34 percent of the Republican respondents supported the health care policy.

The AARP survey also found that 66 percent of the respondents supported allowing Medicare to negotiate lower prescription drug costs to increase the solvency of the program.

Last year, Congress passed legislation that required pharmaceutical companies to contribute more to contribute more to close the Medicare Part D coverage gap to reduce the high out-of-pocket cost of drug costs. The pharmaceutical lobby is working to reverse this requirement. The AARP survey found that 78 percent of the age 50 and over respondents support the existing requirement to contribute more to close the Medicare Part D coverage gap.

Federal law prohibits insurance companies from charging those with pre-existing conditions more for health coverage. While some want to repeal this law because they believe the person should pay more, others say that paying a higher premium is unfair. The AARP survey found that 84 percent of the women and Democrats surveyed were more likely to say that the higher costs of health care is unfair for those with preexisting conditions.

Current federal law allows insurance companies to charge up to three times more for health insurance for those over age 50. Some Congressional lawmakers propose increasing this charge up to five times more for health insurance. Eighty three percent of the older survey respondents oppose this, calling any changes unfair.

Over half of the age 50 older survey respondents have caregiving experiences. Two in five of these respondents believe they will become caregivers. The survey found that 75 percent of the respondent’s support employer requirements for family caregiving. The requirements include: ensuring that employees can not be fired for taking time off for caregiving; allowing the use of existing sick leave for caregiving activities; allowing a limited amount of unpaid and paid leave for use by caregivers.

Eighty seven percent of the AARP survey respondents believe Congress should pass laws to protect caregivers from being fired for taking time off to care for a loved one. Most of these respondents (88 percent) also believe that stronger laws are needed to protect older workers from age discrimination.

Currently, there is discussion on Capitol Hill about the need for a rule that requires professional financial advisors, when giving advice to their older clients about their retirement savings accounts, to give advice that is in the best interest of these individuals. The AARP survey found that 69 percent of the survey respondents agree to this rule.

Phone App Informs Older Voters on Aging Issues

The Washington, DC-based AARP today launches “Raise Your Voice,” the nation’s first comprehensive advocacy and voting app for smart speakers (works on Amazon Alexa and Google Home) . The voice-enabled experience is designed to help older voters to use smart speakers to become educated on a wide range of aging issues — including Social Security, Medicare, prescription drugs, Medicaid and caregiving.

“This groundbreaking skill empowers voters at a time when people are looking for trustworthy, accessible sources of information,” said John Hishta, AARP Senior Vice President of Campaigns, in a statement announcing the Oct. 11 release of the phone app.

To invoke the app, the user simply says their smart speaker’s wake command, followed by “Open Raise Your Voice.” With days before the upcoming midterm elections, the user can direct “Raise Your Voice” to look up polling information and send it directly to the user’s cell phone. Similarly, the user can command the app to provide information on AARP issues.

“Traditional voter education is laudable and important work, but it’s a leap forward to develop technology that better supports voters as they seek out the location of their polling place, information on key issues, and the ability to contact their elected officials,” said Sami Hassanyeh, AARP Senior Vice President of Digital Strategy and Membership. “

The app is available at http://www.aarp.org/raiseyourvoice.

Send a Message to Congress

Robert Roach, Jr., President of the Washington, DC-based Alliance for Retired Americans, calls on older voters to “Know your rights before heading to the polls.” Your state’s Secretary of State’s website can provide details about voter identification requirements and other laws. If you are encountering problems with voting or suspect voter rights at your polling site, seek out an elected official to discuss, suggests Roach. Also, call the voting rights hotline at 1-866-OUR-VOTE (687-8683).

“Bring a snack, a book and even a chair if you think there may be a line. Don’t go home until your vote has been counted,” says Roach. “An unfortunate election result could lead to health insurers charging people aged 50-64 five times more than younger consumers for the same coverage. A good result could lead to an expansion of your earned Social Security benefits,” he says.

Senate Aging Panel Calls for Improved Emergency Preparation and Response

Published in the Woonsocket call on October 8, 2017

“Those who cannot remember the past are condemned to repeat it” — George Santayana, a philosopher, essayist, poet, and novelist

In the wake of Hurricanes Irma and Harvey, after the death of at least nine nursing facility residents due to heat-related illness due to sweltering heat at a Hollywood, Florida-based facility that had lost power to run its air conditioner, the Senate Special Committee on Aging put the spotlight on the challenges facing seniors during natural disasters at a hearing on Sept. 20, 2017.

News coverage of Hurricanes Irma and Harvey provided heartbreaking reminders that seniors and persons with disabilities are particularly vulnerable during a natural disaster. On Florida’s Gulf Coast, an assisted care facility for dementia patients lost electrical power for three days, causing 20 seniors to suffer from high indoor temperatures. Meanwhile, in Dickinson, Texas, a widely-shared photo showed elderly residents of an assisted-living center awaiting rescue as flood waters rose waist deep inside the facility.

Heeding the Lessons from Past Disasters

When Hurricane Katrina slammed into the Gulf Coast 12 years ago, more than half of those who died were seniors, according to a report from the National Institutes of Health. Since that devastating storm, disaster response officials have placed much emphasis at the national, state, and local level to better protect older Americans during an emergency.

“As we have learned from Hurricanes Irma and Harvey as well as past catastrophes such as Hurricane Katrina, some of our neighbors – especially seniors – face many obstacles during a crisis, and we must focus on the attention older adults may need,” said Senators Susan Collins (R-ME) and Bob Casey (D-PA), Chairman and Ranking Member of the Senate Aging Committee in a statement announcing the Senate panel hearing held in 562 Dirksen Senate Office Building.

In her testimony, Dr. Karen B. DeSalvo the former health commissioner for New Orleans after Hurricane Katrina hit the city in 2005, noted that medical records for most patients at the time of Katrina were kept only on paper and were destroyed, “turning to useless bricks,” or lost because of the disaster. For clinicians, treating patients who lost their medicines became a major challenge, she said.

Creating Registries to Protect the Vulnerable

Since Katrina, the New Orleans Health Department has been “working aggressively, to create a medical special needs digitized registry to maintain a list of high-risk individuals, those most in need of medical assistance for evacuation during preparations or in response operations, says Dr. DeSalvo

Dr. DeSalvo called for “leveraging data and technology” as a way of creating more efficient and effective strategies of identifying the most vulnerable in a community. All communities could create such registries by using state Medicaid data to locate where residents who are electricity-dependent live. The electronic system, called emPOWER, is available for use nationally, and she recommended Congress fund training exercises to respond to disasters. response.

A witness, Jay Delaney, fire chief and management coordinator for the City of Wilkes-Barre, Pennsylvania, suggests that Congress continue to fully fund the National Weather Service and the Federal Emergency Management Agency (FEMA). Investing in surveillance tools can enhance decision making by making crucial weather data available before, during, and after a disaster.

For nursing homes and assisted living facilities, it is “critical” they have detailed shelter-in-place emergency plans, says Delaney, but for those who stubbornly choose to not leave their homes during a disaster, preparedness for those is a “tough nut to crack.”

“When you have to evacuate 15,000 people in 10 hours, you don’t have time to say, ‘Mam or sir, here’s why you have to go,’” Delaney said.

In his testimony, Paul Timmons Jr., CEO and president of Portlight Inclusive Disaster Strategies, proposed the establishment of a National Center for Excellence inclusive Disability and Aging Emergency Management to improve emergency management responses to disasters to reduce injuries and save lives. “The initial focus of the center should include community engagement, leadership, training and exercise development, evacuation, sheltering, housing and universal accessibility,” he said, suggesting a five-year, $1 billion budget.

Finally, Witness Kathryn Hyer, a professor in the School of Aging Studies at the University of South Florida in Tampa, provided eight tips for the Senate Aging panel to protect seniors during disasters. She called for emergency plan for nursing homes and assisted living; required generators to support generators in the event of a power failure, more research on what types of patients will benefit from evacuation or sheltering in place; construction of facilities in places that minimize flooding risk; identification of and prioritization for nursing homes and assisted living communities by state and local management organizations for restoration of services; litigation protection for facilities that abide by regulations and provide care during disaster scenarios; and continued commitment to geriatric education programs.

Prioritizing Senior’s Needs in Disasters

On Sept. 26, one week after the Senate Special Committee on Aging hearing on disaster preparedness and seniors, Senators Collins and Casey called for a swift federal response to the growing humanitarian crisis in Puerto Rico and the U.S. Virgin Islands. In correspondence to three federal agencies, they urged the Administration to take all available steps to act swiftly and prioritize seniors in the response to Hurricane Maria The senators also urged the federal agencies to prioritize not only patients in acute health care facilities, but individuals in nursing homes and assisted living facilities, as well as seniors living at home.

“We urge the Administration to heed the lessons of the recent hurricane response efforts in Florida and Texas and take all available steps to prioritize seniors in the response to this devastating storm,” the senators wrote. “Seniors must be quickly identified and resources deployed to ensure that no older American is left in unbearable heat without air conditioning or without water and food as response efforts continue… During this recovery period, it is even more important to multiply our efforts and deploy sufficient resources to support and rescue seniors.

It has been reported that the intensity of North Atlantic hurricanes and the number of Category 4 and 5 hurricanes are increasing. With a high concentration of people and properties in coastal areas were hurricanes strike, it become crucial to learn emergency management lessons gleaned from past hurricanes and disasters, from Hurricane Katrina to Hurricane Irma. The Senate Select Committee on Aging is on the right track in seeking ways to put disaster emergency preparedness on the nation’s policy agenda. Now, it’s time for Congressional standing committees to adequate fund FEMA and the National Weather Service and strengthen emergency preparedness laws.