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.
A Liberal Economist Shoots Down the GOP’s Fiscal Chicken Hawks
Republicans want a tax cut, but they don’t want to fully pay for it and may be willing to increase the deficit by $1.5 trillion over 10 years. This would continue a troubling cycle, economist Jared Bernstein writes, in which supposed fiscal conservatives “use the deficit argument to block spending, promote fiscal austerity, and small government, conveniently tossing deficit concerns aside when it comes to tax cuts.”
You’ll hear arguments about how increased economic growth will make up for the budgetary effects of the tax cuts, but don’t believe them. “Our fiscal history on this point is clear: Cutting taxes loses revenues, which, unless offset by higher taxes elsewhere or spending cuts, increases the budget deficit, which in turn raises the debt.” When this happens again, and the promised growth effects don’t materialize, the tax cutters will go back to pushing for spending cuts.
The country faces a number of serious challenges, including an aging population that by itself will require increased government spending, and we need a tax policy that does more than drive up the deficit. “The problem with structural deficits — ones that go up even in good times — is that they reveal that we’re unwilling to raise the necessary revenues to support the government we want and need. This enables those who whose goal is to shrink government to point to deficits and debt as their proof that we can’t afford it, whatever ‘it’ is, except when ‘it’ is tax cuts.” (New York Times)
Health Secretary Tom Price Under Fire for Use of Private Jets
Back in 2009, Tom Price spoke out against House Democrats who wanted to spend $550 million on private jets for lawmakers to use. A Republican representative from Georgia at the time, Price told CNBC that the purchase of the jets was “another example of fiscal irresponsibility run amok.” Now Secretary of Health and Human Services, Price seems to have changed his mind about the virtue of government officials using private jets at taxpayer expense. Just last week, Price used a chartered private jet to travel to three HHS events — including one at a resort in Maine — at an estimated cost of $60,000, Politico reports.
While previous HHS secretaries typically flew commercial, reports indicate that Price has been traveling by private jet for months. “Official travel by the secretary is done in complete accordance with Federal Travel Regulations,” an HHS spokesperson told Politico.
Critics on Twitter have been harsh:
More in-your-face kleptocracy from Tom Price.Take food stamps from poor, hungry kids- spend $25k from taxpayers to charter plane to Philly
— Norman Ornstein (@NormOrnstein) September 20, 2017
1️⃣ Attack Medicaid while trading health stocks.
— Harry Stein (@HarrySteinDC) September 20, 2017
2️⃣ Spend funds that could give someone 4 years of Medicaid coverage to fly a private jet. https://t.co/GO5cfJgWgO
First Mnuchin, now Tom Price. The @realDonaldTrump Cabinet has a big problem charging taxpayers for private flights. https://t.co/th1QbGdfT7
— Ben White (@morningmoneyben) September 20, 2017
Social Security Benefits Due for a Bigger Bump in 2018
In a few weeks the Social Security Administration will announce its cost-of-living adjustment, or COLA, for 2018. Inflation data for the month of August suggests that the adjustment could be the highest in five years, possibly over 2 percent, according to the Washington Examiner. Adjustments for the past five years have been relatively small: The cost of living adjustment for 2017 (announced last October) came in at a modest 0.3 percent, and the adjustment for 2016 was zero. Some retirees have complained in the past about small COLAs, but it’s worth remembering that higher adjustments are driven by higher inflation, which is bad news for people living on fixed incomes.
Americans Are Less Satisfied with Government Now Than a Year Ago
Gallup finds that just 28 percent of Americans are satisfied with the way the nation is being governed, down from 33 percent a year ago. And as we approach some potential fiscal battles, it's worth noting that the lowest satisfaction levels since Gallup started updating the measure annually in 2001 came in 2011 (19 percent) after a debt ceiling showdown that led to the U.S. credit rating being downgraded by S&P analysts and in 2013 (18 percent) during a federal government shutdown.
Maybe Don’t Count Out Obamacare Repeal Just Yet
Sen. Bill Cassidy (R-LA) told reporters on Friday that he’s getting close to securing enough votes to pass the last-ditch ACA repeal and replacement bill he’s put forth with Sens. Lindsey Graham (R-SC), Dean Heller (R-NV) and Ron Johnson (R-WI).
“I am pretty confident we’ll get there on the Republican side,” Cassidy said. “We’re probably at 48-49 [votes] and talking to two or three more.” And Senate Majority Leader Mitch McConnell has asked the Congressional Budget Office to estimate the effects of the Cassidy-Graham bill, which would speed up the scoring process.
Of course, those last two or three votes have been the challenge for the GOP all along, and they may not be any easier to round up this time. Sen. Rand Paul (R-KY), who voted for a prior repeal bill, said Friday that he won't support this one. Plus, opponents are already stepping up their criticisms about the effects of the bill. And time is running out: Cassidy and his colleagues only have until September 30 to pass the bill this year under a process that would require only 50 supporters in the Senate. So while the Obamacare repeal may still have life, it remains a longshot.