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.
Martin Feldstein Is Optimistic About Tax Cuts, and Long-Term Deficits
In a new piece published at Project Syndicate, the conservative economist, who led President Reagan’s Council of Economic Advisers from 1982 to 1984, writes that pro-growth tax individual and corporate reform will get done — and that any resulting spike in the budget deficit will be temporary:
“Although the net tax changes may widen the budget deficit in the short term, the incentive effects of lower tax rates and the increased accumulation of capital will mean faster economic growth and higher real incomes, both of which will cause rising taxable incomes and lower long-term deficits.”
Doing tax reform through reconciliation — allowing it to be passed by a simple majority in the Senate, as long as it doesn’t add to the deficit after 10 years — is another key. “By designing the tax and spending rules accordingly and phasing in future revenue increases, the Republicans can achieve the needed long-term surpluses,” Feldstein argues.
Of course, the big questions remain whether tax and spending changes are really designed as Feldstein describes — and whether “future revenue increases” ever come to fruition. Otherwise, those “long-term surpluses” Feldstein says we need won’t ever materialize.
JP Morgan: Don’t Expect Tax Reform This Year
Gary Cohn, President Trump’s top economic adviser, seems pretty confident that Congress can produce a tax bill in a hurry. He told the Financial Times (paywall) last week that the Ways and Means Committee should be write a bill “in the next three of four weeks.” But most experts doubt that such a complicated undertaking can be accomplished so quickly. In a note to clients this week, J.P. Morgan analysts said they don’t expect to see a tax bill passed until mid-2018, following months of political wrangling:
“There will likely be months of committee hearings, lobbying by affected groups, and behind-the-scenes horse trading before final tax legislation emerges. Our baseline forecast continues to pencil in a modest, temporary, deficit-financed tax cut to be passed in 2Q2018 through the reconciliation process, avoiding the need to attract 60 votes in the Senate.”
Trump Still Has No Tax Reform Plan to Pitch
Bloomberg’s Sahil Kapur writes that, even as President Trump prepares to push tax reform thus week, basic questions about the plan have no answers: “Will the changes be permanent or temporary? How will individual tax brackets be set? What rate will corporations and small businesses pay?”
“They’re nowhere. They’re just nowhere,” Henrietta Treyz, a tax analyst with Veda Partners and former Senate tax staffer, tells Kapur. “I see them putting these ideas out as though they’re making progress, but they are the same regurgitated ideas we’ve been talking about for 20 years that have never gotten past the white-paper stage.”
The Fiscal Times Newsletter - August 28, 2017
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The IRS Gives Hurricane Harvey Victims a Break
The tax agency announced Monday that “victims in parts of Texas have until Jan. 31, 2018, to file certain individual and business tax returns and make certain tax payments.”