Why Prescription Drug Prices Keep Rising – and 3 Ways to Bring Them Down
Prescription drug prices have been rising at a blistering rate over the last few decades. Between 1980 and 2016, overall spending on prescription drugs rose from about $12 billion to roughly $330 billion, while its share of total health care spending doubled, from 5% to 10%.
Although lawmakers have shown renewed interest in addressing the problem, with pharmaceutical CEOs testifying before the Senate Finance Committee in February and pharmacy benefit managers (PBMS) scheduled to do so this week, no comprehensive plan to halt the relentless increase in prices has been proposed, let alone agreed upon.
Robin Feldman, a professor at the University of California Hastings College of Law, takes a look at the drug pricing system in a new book, “Drugs, Money and Secret Handshakes: The Unstoppable Growth of Prescription Drug Prices.” In a recent conversation with Bloomberg’s Joe Nocera, Feldman said that one of the key drivers of rising prices is the ongoing effort of pharmaceutical companies to maintain control of the market.
Fearing competition from lower-cost generics, drugmakers began over the last 10 or 15 years to focus on innovations “outside of the lab,” Feldman said. These innovations include paying PBMs to reduce competition from generics; creating complex systems of rebates to PBMs, hospitals and doctors to maintain high prices; and gaming the patent system to extend monopoly pricing power.
Feldman’s research on the dynamics of the drug market led her to formulate three general solutions for the problem of ever-rising prices:
1) Transparency: The current system thrives on secret deals between drug companies and middlemen. Transparency “lets competitors figure out how to compete and it lets regulators see where the bad behaviors occur,” Feldman says.
2) Patent limitations: Drugmakers have become experts at extending patents on existing drugs, often by making minor modifications in formulation, dosage or delivery. Feldman says that 78% of drugs getting new patents are actually old drugs gaining another round of protection, and thus another round of production and pricing exclusivity. A “one-and-done” patent system would eliminate this increasingly common strategy.
3) Simplification: Feldman says that “complexity breeds opportunity,” and warns that the U.S. “drug price system is so complex that the gaming opportunities are endless.” While “ruthless simplification” of regulatory rules and approval systems could help eliminate some of those opportunities, Feldman says that the U.S. doesn’t seem to be moving in this direction.
Read the full interview at Bloomberg News.
Small Business Owners Say They’re Raising Worker Pay
A record percentage of small business owners say they are raising pay for their workers, according to the latest monthly jobs report from the National Federation of Independent Business, based on a survey of 10,000 of the group’s members. A seasonally adjusted net 35 percent of small businesses say they are increasing compensation. “They are increasing compensation at record levels and are continuing to hire,” NFIB President and CEO Juanita Duggan said in a statement accompanying the report. “Post tax reform, concerns about taxes and regulations are taking a backseat to their worries over filling open positions and finding qualified candidates.”
The US Is Running Short on More Than 200 Drugs
The U.S. is officially running short on 202 drugs, including some medical staples like epinephrine, morphine and saline solution. “The medications most vulnerable to running short have a few things in common: They are generic, high-volume, and low-margin for their makers—not the cutting-edge specialty drugs that pad pharmaceutical companies’ bottom lines,” Fortune’s Erika Fry reports. “Companies have little incentive to make the workhorse drugs we use most.” And much of the problem — “The situation is an emergency waiting to be a disaster,” one pharmacist says — can be tied to one company: Pfizer. Read the full story here.
Chart of the Day: Could You Handle a Sudden $400 Expense?
More Americans say they are living comfortably or at least “doing okay” financially, according to the Federal Reserve’s Report on the Economic Well-Being of U.S. Households in 2017. At the same time, four in 10 adults say that, if faced with an unexpected expense of $400, they would not be able to cover it or would cover it by selling something or borrowing money. That represents an improvement from 2013, when half of all adults said they would have trouble handling such an expense, but suggests that many Americans are still close to the edge when it comes to their personal finances.
Kevin Brady Introduces Welfare Reform Bill
The Tax Policy Center’s Daily Deduction reports that Rep. Kevin Brady (R-TX), chair of the House Ways and Means Committee on Friday introduced The Jobs and Opportunity with Benefits and Services (JOBS) for Success Act (H.R. 5861). “The bill would rename the Temporary Assistance for Needy Families (TANF) program and target benefits to the lowest-income households. Although the House GOP leadership promised to include an expansion of the Earned Income Tax Credit as part of an upcoming welfare reform bill, this measure does not appear to include any EITC provisions.” The committee will mark up the bill on Wednesday.
Who Will Pay the AMT in 2018?
The GOP tax cuts expanded an exemption for the Alternative Minimum Tax (AMT) and changed tax breaks that often triggered the tax. As a result, The Wall Street Journal’s Laura Saunders reports, “This year’s AMT is a shadow of its former self. It is expected to raise about $5 billion for 2018, down from an estimated $39 billion under prior law, according to the Tax Policy Center.” The AMT will likely hit some 200,000 tax filers for 2018, down from roughly 5 million who would have had to pay if the tax cuts hadn’t been passed. And the number of people making $500,000 or less who owe the AMT will fall to about 120,000 this year from 4 million last year, a Tax Policy Center economist tells the Journal.