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.
Tax Reform Is Hard, but the GOP Could Have Made This Easier
The Tax Policy Center’s William G. Gale writes that the GOP’s approach to the tax bill combines a $5.8 trillion tax cut with a $4.3 trillion tax increase to offset the costs. There may have been an easier way. “What if the House GOP simply tried to cut business and individual taxes by $1.5 trillion. No offsets needed. They could have distributed small tax cuts to middle-income individuals by, say, modestly expanding the earned income tax credit and raising the standard deduction. And they could have trimmed the top corporate tax rate by a few percentage points. It would not have been base-broadening tax reform, but neither is the current bill. ... Tax reform is never easy, but crafting the bill this way has vastly increased the challenge of passing it.”
Alan Greenspan: Deal with the National Debt Before Cutting Taxes
Former Federal Reserve Chairman Alan Greenspan is warning that sharply cutting taxes right now would be an economic “mistake.”
In an interview with Maria Bartiromo on the Fox Business Network Thursday, the 91-year-old Greenspan said it’s more important for President Trump and Congress to put the nation on a sustainable fiscal path by addressing rising entitlement spending driven by the aging of the U.S. population.
“Frankly, I think what we ought to be concerned about is the fact the federal debt is rising at a very rapid pace, and there’s nothing in this bill that will essentially stop that from happening," Greenspan said. "So my view is that we’re premature on fiscal stimulus, whether it’s tax cuts or expenditure increases. We’ve got to get the debt stabilized before we can even think in those terms.”
GOP’s Estate-Tax Repeal Details Would Save Super-Rich Tens of Billions Extra
It’s no surprise that the House Republicans’ tax bill includes the eventual repeal of the estate tax, a long-held GOP goal. But The Washington Post’s Glenn Kessler highlights an unexpectedly generous aspect of the current bill: It “allows the beneficiaries of estates to not pay capital gains taxes on the increase in value of assets held by the estates. That has not been a feature of most previous estate-tax bills.”
Currently, estates face a federal tax if they’re valued at more than $5.49 million for individuals or almost $11 million for couples. But, for tax purposes, the value of assets passed on to heirs gets “stepped-up” or reset to their value at the time of death. Kessler’s example: “Imagine a home that had been purchased for $250,000 but was now worth $1 million. The ‘stepped-up basis’ would be $1 million. If the heirs sold the house for $1.1 million, they would only owe capital-gains tax on the $100,000 difference, not the $850,000 difference from the original purchase price.”
The GOP bill repeals the estate tax, but also keeps the stepped-up basis — a seemingly small detail that creates a huge tax shelter. It means that heirs of large estates would save tens of billions of dollars a year when they sell assets that have appreciated in value over time — or, as Kessler puts it, that the bill will allow “tens of billions of untapped capital gains to remain beyond the reach of the U.S. government.”
Republicans Are Still Coming After Obamacare’s Individual Mandate
Speaker Paul Ryan said Sunday that House Republicans are still considering a repeal of the Obamacare individual mandate as part of their tax bill. "We have an active conversation with our members and a whole host of ideas on things to add to this bill. And that’s one of the things that’s being discussed," Ryan said on Fox News. President Trump touted the idea in a tweet last week, and Sens. Tom Cotton and Rand Paul have recently spoken in favor of using the tax bill to eliminate the mandate. The move would save the government $416 billion over 10 years as roughly 15 million people go without insurance due to lower spending on subsidies and health care services, according to the CBO. Those savings could be appealing as Republicans look for revenues in their revised tax bill. But if the controversial repeal of the mandate isn’t included in the tax bill, the White House is reportedly ready to roll out an executive order weakening the requirement that taxpayers provide proof of insurance to avoid paying a penalty.
Goldman Sachs Says Corporate Tax Rate Cuts May Get Phased In
Despite the challenges the Republican tax overhaul faces, Goldman Sachs still puts the chances of a plan becoming law by early next year at about 65 percent — but its analysts see some substantial changes coming before that happens. “The proposed tax cut is more front-loaded than we have expected; official estimates suggest a tax cut of 0.75% of GDP in 2018. However, we expect the final version to have a smaller near-term effect as competing priorities lead tax-writers to phase in some cuts—particularly corporate rate cuts—over time,” Goldman said in a note to clients Sunday.