By Anisha Sehgal
Both consumers and healthcare payers are struggling with the rising price of drugs. Unless meaningful reforms are enacted, this problem will only get larger and patients will continue to face crippling out-of-pocket costs in order to care for themselves and their loved ones. The Medicare Part B demonstration is an example of such a reform and would begin to repair the dysfunctional way that we pay for prescription drugs. Unfortunately for patients, the pharmaceutical industry has mounted considerable opposition to this reform and it is not alone. Politicians and organizations such as patients’ groups have also voiced their objection. However, the majority of these individuals and groups have received industry funding.
A recent Public Citizen report revealed that of the 147 patients’ groups who have signed letters objecting to the Medicare Part B demonstration at least 110 (75%) received funding from pharmaceutical or medical device corporations. Since patients’ groups are not required to disclose their funding sources there may be even more than the 110 groups identified by the report that received money from pharma.
The letter organized by the Community Oncology Alliance was sent to congressional leadership while the letter organized by the Partnership to Improve Patient Care was sent to the Center for Medicare and Medicaid Services (CMS). Along with the 147 patients’ groups, 241 doctors’ groups and pharmaceutical industry groups — both of which benefit from the maintaining the status quo of the current reimbursement method — signed either of the two letters opposing the reform. The letters’ combination of patients’ groups as well as industry groups, such as local Biotechnology Innovation Organization (BIO) affiliates, demonstrates the close ties patients’ groups have with the pharmaceutical industry.
In 2015, Part B spending reached $22 billion, double the amount it was in 2007. A reform such as this is necessary in order to remedy Medicare Part B’s unsustainable spending trend. The Medicare Part B demonstration, which is supported by numerous consumer interest groups including Public Citizen, aims to remove incentives for doctors to unnecessarily prescribe higher priced medicines when effective and affordable alternatives are available. Currently a physician who administers a drug under Medicare Part B will be reimbursed for the average sales price plus six percent. The demonstration proposes changing the reimbursement to the average sales price plus 2.5 percent and a flat dollar amount.
The pharmaceutical industry is strongly opposed to this reform because a decrease in the prescription of higher-priced drugs means a decrease in the industry’s profits. In fact, the industry has already spent more than $9 million in campaign funding for members of Congress, which is strongly correlated with lawmakers’ stances on the issue, as revealed by another recent Public Citizen report.
The pharmaceutical industry’s troubling pattern of influence raises questions about the independence of this reform’s opponents. Patients’ groups should reconsider their stance on this issue and realize that in this debate pharma is only looking out for itself, not for the deserving patients of this country.
Besides using their normal tools to attack life-saving public protections, Republicans have once again chosen to exploit the budget process. Instead of relying on anti-regulatory bills and (at times theatrical) Congressional hearings, the majority party in the House has decided to go down the path of inserting poison pill riders into the budget appropriations process.
Poison pill riders are preventing the U.S. Fish and Wildlife Service from fulfilling its obligations under the Endangered Species Act.
From attacking science-based safeguards in a full frontal manner to using attempted stealth maneuvers to further delay an already bogged down rulemaking system, Republicans have not let up. Nearly all of the House appropriation bills currently up for debate or voted on contain regulatory assaults:
- Killing specific final safeguards by blocking funding for the implementation, administration or enforcement – ex. Department of Labor’s fiduciary and overtime rules, preventing the enforcement of the Environmental Protection Agency’s (EPA) rules to limit exposure to lead paint and the Bureau of Safety & Environmental Enforcement Well Control rule which provide commonsense protection against devastating offshore blowouts like Deepwater Horizon.
By also using stealthier methods and not just attacking specific protections, proposed standards or specific agencies, Republicans are further exploiting appropriation funding bills by adding poison pill riders to shut down the rulemaking system entirely. Since each funding bill covers multiple agencies and different areas, all-encompassing riders have the most devastating impact.
- Repeat riders have emerged in various bills to shut down any rulemakings the bill would have funded – ex. the House Financial Services & General Government (FSGG) bill included a rider to prohibit the funding of all regulatory actions until January 21, 2017, and the same rider materialized in the House Interior bill.
- In some cases, Republicans repeated the above riders but with a timeline attached – ex. a so-called midnight rules prevention rider surfaced in the House Energy & Water bill would eliminate funding for all rules with an economic impact of $100 million or more if finalized between November 8, 2016 and January 20, 2017.
- As another stealth maneuver, Republicans in the House FSGG bill voted to add a piece of legislation to the mix, H.R. 427, the Regulations From the Executive in Need of Scrutiny Act (REINS). Putting the ill-advised REINS Act into law would require Congressional approval before enacting major regulations – allowing the majority party a golden opportunity to kill the most life-saving public protections.
There’s a reason lawmakers sneak poison pill policy riders into must-pass spending bills to avoid a real debate: these provisions could not become law on their own merits. Many of them are wildly unpopular, damaging to the public and deeply controversial with voters in both parties — and they have nothing to do with funding our government.
That’s why Congress needs to pass clean spending bills with no poison pill riders and Republicans need to stop their assault on life-saving public protections.
Michell K. McIntyre is Coalition Manager at the Coalition for Sensible Safeguards.
By Will Neer and Anisha Sehgal
Imagine being diagnosed with a life threatening illness. The immediate reactions of shock and panic may also be mixed with relief once your doctor informs you that there is an effective treatment available. However, that relief can quickly disappear and instead be replaced with hesitation and fear once the hefty price tag associated with the treatment is revealed. This unfair cycle of emotions is a process too many Americans and their families are forced to experience due to astronomical drug prices.
A type of drug commonly used to treat serious illnesses is a biologic. However, as prescription drug corporations often charge more than $100,000 annually for biologic treatments, many Americans are fighting insurer rationing or even turning to pill splitting. A piece of bipartisan legislation, S. 0394 / H.R. 5573, titled the Price, Relief, Innovation and Competition for Essential Drugs (PRICED) Act aims to remedy this problem. The PRICED Act would amend U.S. law and shorten the time that prescription drug corporations have monopolies on biologic medicines – and how long they can charge monopoly prices, thereby making these treatments more readily accessible.
By Anisha Sehgal
During election season, Americans across the country hear politicians make grand statements on how they will look out for the good, hard-working people of their state and push for progress that will benefit us all. As we watch them head off to Washington we expect or at least hope that they will deliver on their promises and act in a manner that looks out for our best interests.
However, a recent Public Citizen report on the role of corporate money in politics has revealed the strong influence donations can have on swaying lawmakers’ support on big issues. We are in the midst of a contentious debate regarding the Centers for Medicare and Medicaid Services’ (CMS) proposed Medicare Part B demonstration, a proposal strongly opposed by the pharmaceutical industry. Public Citizen’s new study reveals that members of Congress who opposed or were critical of the reform on average received 82% more in campaign contributions for the 2016 election cycle from the pharmaceutical and health products industry than rank and file members who did not take a stance against the reform.