HHS plan to lower prescription drug costs is a good start, but we need bold, swift action

HHS recently announced a plan supporting legislation that would allow it to negotiate Medicare Part B and Part D drug prices directly with pharmaceutical companies and then make those prices available to other purchasers, in addition to other key policy proposals to lower medication costs.

In this guest editorial, Rita K. Kuwahara, MD, MIH, a primary care health policy fellow and internal medicine physician at Georgetown University, weighs in on the HHS plan and discusses how affordable drugs would enable providers to shift their focus from reactive care to preventive medicine, which in turn would improve health outcomes and lower overall health care costs.

As a primary care physician, I have seen firsthand how access to affordable medicines can mean the difference between life and death for my patients.

For my patients with diabetes who require insulin to survive, it is unacceptable that their ability to live or die depends on the type of prescription drug insurance coverage they have and whether they can afford the skyrocketing cost of insulin.

We are at a critical point in time where our nation has the ability to make medicines affordable for all, but it is vital that we place health over politics and show that, as a nation, we have a goal to ensure that everyone is able to access the medicines they need when they need them.

The Biden-Harris administration should be applauded for its leadership and commitment to lower prescription drug prices. This is a great first step, but much more can and should be done, and the administration has the power to do this.

Every person in our nation needs access to affordable medicines now, and we cannot afford to wait. We are currently in the midst of a pandemic, which has made essential medicines financially inaccessible to many people who have lost jobs and employer-sponsored health insurance, and inaction will cost lives.

Pharmaceutical companies have for too long profited off individuals’ poor health and benefited from generous policies that allow their profits to grow unchecked. For example, pharmaceutical companies set the drug prices; unlike other high-income countries, the United States does not negotiate these prices, leading to prescription drug costs that are 2.5 times higher than other high-income nations, according to a RAND Corporation report. Further, even during the pandemic, a recent AARP report found that “between 2019 and 2020, retail prices for 260 widely used brand-name prescription drugs increased by 2.9 percent, more than two times faster than general inflation.”

While I hope that Congress will be able to come together and enact comprehensive legislation to make medicines affordable for everyone in our nation, it is critical for the administration to use the full power of the executive branch to ensure that every person has access to affordable, lifesaving medicines whenever they need them, since illness is never planned and health should not be a commodity, but rather a human right.

It only makes sense that in a free market economy, Medicare should be able to negotiate prescription drug prices, and since pharmaceutical companies already benefit from taxpayer funds that support initial drug development, mechanisms should be put in place to limit patients’ additional out-of-pocket costs for prescription drugs.

In the current model, it is important to note that patients often end up paying two to three times for their medicines. They first pay through their taxes that support NIH funding, since all 356 drugs that were approved by the FDA between 2010 and 2019 had support from NIH funding. Our patients pay a second time through their health insurance premiums, which continue to rise with the rising cost of health care in the United States. They are then charged a third time when they pick up their medicines from the pharmacy.

The out-of-pocket medication costs that families pay at the pharmacy counter have also been rising as copays increasingly depend on drug price tiering, rising health insurance deductibles and increasing shifts from copays to percentage of coinsurance owed by patients to purchase their prescription drugs.

Since access to affordable medications is essential to maintaining good health, we need bold and decisive action now to lower the cost of prescription drugs and make medicines affordable for all so each of our patients and everyone in our community can access the medicines they need.

As a member of the National Steering Committee for Prescription Drug Affordability at Doctors for America, my colleagues and I have continued to advocate for strategies to lower the costs of medicines for our patients through executive and legislative action.

During HHS Secretary Xavier Becerra’s confirmation process earlier this year, Doctors for America sent key questions on drug affordability to the Senate Finance Committee to ask Becerra, highlighting some of the issues that the administration has the authority to act on. These included advocating for the use of “federal authority to lay claim to treatments and vaccines for COVID-19 to ensure affordable access for all,” commitment “to any available mechanisms (e.g. march-in rights, Section 1498, Defense Production Act) to ensure that Americans don’t continue to receive a bad deal from pharmaceutical corporations that bar access to life-saving treatments and vaccines that they are true investors of,” ensuring the “NIH and FDA enforce penalties for failures and delays in reporting clinical trials results,” supporting “efforts to ensure that Medicare and other insurers can negotiate directly with pharmaceutical corporations to lower the cost of all prescription drugs,” and “offering a total of 5 years of exclusivity for all biologic drugs instead of the current 12 years that has led to exorbitantly high monopoly pricing for these treatments.”

These concrete proposals, some of which the administration has already embraced, represent examples of policies that can be used to create a framework for action that the administration can take to lower prescription drug costs for everyone in our nation.

It is not fair that our current system prioritizes profits over health, causing us to see patients every day who cannot afford their medicines. We urgently need access to affordable medicines for everyone so that we can improve the health of our nation.

This is even more apparent during the COVID-19 pandemic, with many families no longer able to afford necessary medicines due to depleted finances and loss or change of insurance coverage. At the same time, however, the COVID-19 pandemic has given us a glimpse of how we can improve public health and the health of our communities if we make health care accessible and affordable for all.

For the first time as a practicing physician in the United States, when patients come to me and need to be vaccinated against COVID-19, I can now tell them that they can get the vaccine regardless of insurance type, their ability to pay and how much money is in their bank account simply because, as taxpayers, they have already paid for the development, purchase and distribution of COVID-19 vaccines, and the vaccines, purchased by the government using taxpayer funds, are now available without additional cost-sharing for patients. That has been critical, especially as we are trying to increase vaccination rates to keep everyone safe. If only we had that same luxury to be able to, for example, ensure that patients with diabetes have access to insulin, we would not have individuals with diabetes dying or developing severe complications because they had to ration or completely forgo taking their insulin due to cost.

Regarding the COVID-19 vaccines, since the government and taxpayers have already invested significant funds in the development and distribution of the vaccines, the government should have the ability to negotiate the price of the vaccines as large-scale vaccination drives are held throughout the country in an effort to curb the current pandemic, rather than having to pay increasingly higher prices for the vaccines as the manufacturers arbitrarily raise the price, which will ultimately increase health care expenditure and increase taxpayer costs.

It is critical that we, as a nation, make medicines affordable for all, so that we may practice preventive medicine rather than reactive care and, in the process, lower overall health care costs by placing the focus on achieving improved health outcomes so that everyone is healthy enough to live and work and care for their families.

As physicians, we must give voice to our patients and use our power to communicate our patients’ experiences of being unable to afford essential medicines to advocate for prescription drug pricing policy reform.

It is highly encouraging that the administration has voiced a commitment to lower prescription drug prices, but now, more than ever, it is vital that the administration and Congress act swiftly to implement comprehensive policy reform using the full authority of the executive branch and through strong legislative action to improve access to affordable medicines for all, so that we can keep our communities and families healthy and improve the health of our nation.

References:

• AARP. Trends in retail prices of brand name prescription drugs widely used by older Americans, 2006 to 2020. https://www.aarp.org/content/dam/aarp/ppi/2021/06/trends-in-retail-prices-of-brand-name-prescription-drugs-widely-used-by-older-americans.10.26419-2Fppi.00143.001.pdf. Accessed Sept. 13, 2021.
• Doctors for America. Doctors for America sends key questions on drug affordability to Senate Finance Committee to ask of Department of Health and Human Services Secretary Nominee Xavier Becerra. https://www.drsforamerica.org/about-us/press-releases/press-release-doctors-for-america-sends-key-questions-on-drug-affordability-to-senate-finance-committee-to-ask-of-department-of-health-and-human-services-secretary-nominee-xavier-becerra/. Accessed Sept. 11, 2021.
• HHS. Comprehensive plan for addressing high drug prices: A report in response to the executive order on competition in the American economy. https://aspe.hhs.gov/sites/default/files/2021-09/Competition%20EO%2045-Day%20Drug%20Pricing%20Report%209-8-2021.pdf. Accessed Sept. 10, 2021.
• HHS. Comprehensive plan for addressing high drug prices: A report in response to the executive order on competition in the American economy. Executive Summary. https://aspe.hhs.gov/sites/default/files/2021-09/Drug%20Pricing%20HHS%20Exec%20Sumary%209-8-21.pdf. Accessed Sept. 10, 2021.
• HHS. HHS Secretary Xavier Becerra releases bold proposal to lower prescription drug costs. https://www.hhs.gov/about/news/2021/09/09/hhs-secretary-xavier-becerra-releases-bold-proposal-lower-prescription-drug-costs.html. Accessed Sept. 10, 2021.
• Hopkins JS. U.S. buys 200 million COVID-19 vaccines from Pfizer and BioNTech at about $24 a shot. https://www.wsj.com/articles/u-s-buys-200-million-covid-19-vaccines-from-pfizer-and-biontech-at-about-24-a-shot-11627078710. Accessed Sept. 13,2021.
• Kaiser Family Foundation. Price increases continue to outpace inflation for many Medicare Part D drugs. https://www.kff.org/medicare/issue-brief/price-increases-continue-to-outpace-inflation-for-many-medicare-part-d-drugs/. Accessed Sept. 13, 2021.
• RAND Corporation. U.S. prescription drug prices are 2.5 times those in other OECD countries. https://www.rand.org/pubs/research_briefs/RBA1296-1.html. Accessed Sept. 13, 2021.

Editor’s note: This interview reflects the views and opinions of Kuwahara and not her affiliations or institutions.