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.
Is a Fix for Obamacare Taking Shape?
Senators on the Committee on Health, Education, Labor and Pensions heard from governors Thursday in the second of four scheduled hearings on stabilizing Obamacare. The common theme emerging from the testimony was flexibility: "Returning control to the states is prudent policy but also prudent politics," said Utah Gov. Gary Herbert, a Republican. He was joined by Democrat John Hickenlooper of Colorado, who said that states need room to innovate and learn from their mistakes. Much of what the governors said was in line with what the Senate panel is already considering, including the continuation of cost-sharing subsidies to insurance companies. (CBS News, Axios)
Senate Approves Trump's Deal with Dems. Will the House Go Along?
The Senate on Thursday voted to fund the government and increase the federal borrowing limit through December 8 as part of a deal that also included $15.25 billion in hurricane disaster relief funding and a short-term extension of the National Flood Insurance Program. The bill passed by a vote of 80-to-17, with only Republicans voting against the bill.
The package now goes back to the House, where it likely faces more strenuous resistance. The Republican Study Committee, a conservative caucus with more than 155 members, on Thursday announced it opposed the deal because it does not include spending cuts. Rep. Mark Walker, the group's chairman, sent a letter to House Speaker Paul Ryan listing 19 policy changes to "address the growing debt burden" or "begin draining the swamp" that could win conservative support for raising the debt ceiling. Some Democrats may also vote against the deal to signal their frustration with an agreement that they say weakened their hand in trying to protect undocumented immigrants who were brought into the country as children.
White House Backs Off Shutdown Threat…for Now
“Believe me, if we have to close down our government, we’re building that wall,” President Trump said of his planned border wall with Mexico 10 days ago. Just two days later, though, White House officials told Congress that a short-term spending bill to fund the government into December wouldn’t have to include $1.6 billion for the wall, The Washington Post reports.
Trump still wants money for the wall to be included in a December budget bill, and he could follow through on his shutdown threat at that point. For now, though, an agreement on a “continuing resolution” to keep the government running after September 30 seems likelier, allowing Congress to deal with some of the other pressing issues it faces this month.
Which Trump Agenda Items Are Companies Talking About With Wall Street?
Hamilton Place Strategies, a public affairs consulting firm, analyzed transcripts of earnings calls by publicly traded U.S. companies over the last three quarters. They found that tax reform was the policy issue companies discussed most on those calls with Wall Street analysts — but that mentions of the subject dropped by 38 percent from the fourth quarter of 2016 to the second quarter of 2017. Overall, the percentage of earnings calls mentioning government or policy issues fell from 41 percent to 16 percent. Health-care reform saw the largest increase.
Does this mean that businesses have given up on tax reform this year? Perhaps. More likely, it's simply the result of a lack of action on the tax overhaul. Hamilton Place notes that mentions of tax policy peaked in February just after the Senate Finance Committee advanced Treasury Secretary Steven Mnuchin's nomination and have spiked after other tax-related announcements. So mentions of tax reform on earnings calls could surge again the fall.
One other note about what businesses have been discussing: Calls mentioning President Trump fell by 84 percent from January to late August.
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Number of the Day: 51%
More than half of registered voters polled by Morning Consult and Politico said they support work requirements for Medicaid recipients. Thirty-seven percent oppose such eligibility rules.