Controlling drug prices — it’s possible

Agreat success of modern America is the development of medicines to treat so much of what ails us. The United States knows how to develop and deliver drugs to fight disease and improve health — but success hardly comes cheap. Spending on prescription drugs is rising, with many people unable to purchase the medicines they or relatives need. The country cannot be healthy if people can’t afford prescriptions, especially ones to manage long-term conditions or ones that mean the difference between life and death. The situation has become so bad, in fact, that the prestigious National Academies of Sciences reported late last month that “consumer access to affordable medicines is a public health imperative.”

When only people with wealth or access to decent insurance plans can buy medicine without worry, then the health of people across the country will depend on the weight of their pocketbooks, not the nature of their sickness. That’s wrong.

Of course, the rising cost of medicine is hardly new — but the inability of some to pay is becoming worse. The report’s strength is not just presenting evidence of the problem but in developing serious policy recommendations that could improve life for millions of Americans. It does so by focusing on what is described as the biopharmaceutical supply chain — including researchers, doctors, public and private payers, and so many others.

At the heart of the report are recommendations to improve the affordability of prescription drugs, while at the same time, still encouraging the development of effective drugs. Key to ensuring access is using the purchasing power of the government to negotiate drug prices with producers and suppliers of medicine.

Bargaining power can lower prices, and with the U.S. Department of Health and Human Services (along with states that want to join in) negotiating, the seller and purchaser would have a more level playing field. Specifically, the writers of the report want Congress to allow Medicare to negotiate prices with drugmakers and amendments to the Medicaid law so that states can deny certain drugs if less costly medicines will provide the same benefit.

In addition to changing existing laws to allow such negotiations, the report recommends making formulary design less rigid. A formulary — the list describing which drugs will be covered by health care providers for which diseases — is key in health care because of how the drugs are priced.

Formularies often place different drugs in different price categories, meaning that the drug most needed for a certain illness might be assigned a higher cost. That means an insurer might not cover costs and a patient who can’t afford to pay out of pocket will suffer. Any sick person who has tried to pay for an expensive cancer drug not covered by insurance understands the necessity of ensuring that the costs of essential drugs aren’t out of reach for an average person.

Negotiating drug prices is somewhat controversial, with Democrats generally backing the idea and congressional Republicans against — although President Donald Trump supported the idea during the 2016 campaign. Perhaps there is a place for bipartisan agreement, with the Republican president and Democrats in Congress joining to make a deal.

The costs of health care, after all, cannot be contained without controlling the price of prescription drugs.

Other recommendations include moving effective generic drugs into the market more quickly, changes to how prescription drugs are priced and sold, and denial of tax deductions for drug advertising aimed at consumers. The report calls the need for reform urgent — more than half of all U.S. residents routinely use prescription drugs, and 15 percent take five or more regularly.

Of course, considering how much money the prescription drug industry and others in the medical field donate to politicians, there might be little incentive to look for ways to help consumers over companies. That’s where citizens will come in and why this report is important — with the National Academies of Sciences weighing in and citizens speaking up, perhaps Congress can come back from winter break ready to work on legislation that helps, not hurts, people.