Bat­tle over drug prices is shap­ing up

Doggett, other con­gres­sional Dems plan quick ac­tion

San Antonio Express-News (Sunday) - - Front Page - By Bill Lam­brecht

WASHINGTON — Af­ter tap­ping elec­tion sea­son out­rage over ris­ing pre­scrip­tion drug costs, Texas Rep. Lloyd Doggett and vic­to­ri­ous House Democrats in­tend to move quickly in the new Congress with pro­pos­als to pro­tect con­sumers from price spikes and ease the fi­nan­cial crush on Medi­care.

Pres­i­dent Don­ald Trump and Se­nate Repub­li­cans say they’re open to drug-price leg­is­la­tion, but Democrats face the twin ob­sta­cles of a po­tent drug in­dus­try lobby and fear of putting the gov- ern­ment deeper into the health care busi­ness.

With Demo­cratic takeover of the House in the new Congress, Doggett will be in po­si­tion to in­flu­ence health care pol­icy as he did in 2010 in help­ing en­gi­neer pas­sage of the Af­ford­able Care Act.

Doggett, whose dis­trict stretches from San An­to­nio to Austin, chairs a House Demo­cratic task force on drug pric­ing and is in line to take over the Ways and Means health care sub­com­mit­tee next year.

He’s chief spon­sor of far-reach­ing leg­is­la­tion giv­ing Medi­care au- thor­ity to ne­go­ti­ate di­rectly with drug­mak­ers and is mov­ing swiftly to con­sol­i­date sup­port.

The law would al­low the gov­ern­ment to ne­go­ti­ate on be­half of veter­ans. The Medi­care pre­scrip­tion drug ben­e­fit in place since the George W. Bush ad­min­is­tra­tion for­bids such ne­go­ti­a­tions.

Doggett is hop­ing Trump, who has ac­cused the phar­ma­ceu­ti­cal in­dus­try of “get­ting away with mur­der,” will be an ally in lift­ing the pro­hi­bi­tion.

“As much as I dis­agree with Pres­i­dent Trump on just about ev­ery­thing, I’m hope­ful that we can

find some com­mon ground. I’m hop­ing that on this is­sue he will be­gin act­ing more like can­di­date Trump,” Doggett said.

Doggett will be joined by fel­low drug-in­dus­try an­tag­o­nists. Mary­land Demo­crat Eli­jah Cum­mings, who once spoke of “very ex­pen­sive cham­pagne pop­ping in drug in­dus­try board rooms,” will chair the House Over­sight and Gov­ern­ment Re­form Com­mit­tee.

It was that com­mit­tee that sum­moned My­lan’s CEO to ex­plain the com­pany’s six-fold rise in the price of the EpiPen, an in­jec­tor that wards off al­lergy at­tacks.

The in­dus­try also can ex­pect a less hos­pitable Se­nate, even though it re­mains in GOP hands.

Utah Repub­li­can Or­rin Hatch, known for di­vert­ing drug-pric­ing pro­pos­als to the leg­isla­tive grave­yard as chair the Se­nate Fi­nance Com­mit­tee, is re­tir­ing. He’ll be re­placed by no-non­sense Sen. Chuck Grass­ley of Iowa, who coau­thored an in­ves­ti­ga­tion of Gilead’s de­ci­sion to sell its hepati­tis C drug for $84,500 per treat­ment.

In the House, Doggett’s Medi­care ne­go­ti­a­tion bill has emerged as the Democrats’ main plan of ac­tion thus far, at­tract­ing 100 cospon­sors and scores of en­dorse­ments. Pro­jected rev­enues of more than $350 bil­lion in 2018 for the top 10 drug man­u­fac­tur­ers help to make his case.

Stud­ies show pre­scrip­tion prices in the United States are more than twice as high as in other devel­oped coun­tries, ac­cord­ing to com­par­isons pub­lished by Health and Hu­man Ser­vices. One-fourth of Amer­i­cans say they have a hard time pay­ing for their medicine, the Kaiser Foun­da­tion’s Health Track­ing Poll found.

Per capita drug spend­ing grew at a slower rate re­cently af­ter in­creases of up to 11.5 per­cent an­nu­ally when an ar­ray of new spe­cialty drugs came on the mar­ket.

But the an­nounce­ment by drug gi­ant Pfizer last week that it will raise prices of 41 of its medicines Jan. 15 likely will re­new con­cerns and add pres­sure on Congress to act

For Medi­care, the price boosts are drain­ing.

Medi­care’s share of na­tional health spend­ing leapt from 2 per­cent to 29 per­cent over a decade, mak­ing Medi­care the na­tion’s sec­ond big­gest spender on drugs, be­hind pri­vate in­sur­ance.

De­ploy­ing gov­ern­ment pur­chas­ing power would re­duce prices, save tax­payer dol­lars and lower se­niors’ out-of-pocket costs, Doggett and his al­lies con­tend.

The chal­lenge is find­ing a price. What hap­pens if that ne­go­ti­a­tion fails is what likely will trig­ger de­bate.

The gov­ern­ment then could is­sue a li­cense al­low­ing other man­u­fac­tur­ers to pro­duce the drug for Medi­care with the goal of lower prices through com­pe­ti­tion.

The leg­is­la­tion would give pro­tec­tion from “price goug­ing,” as Doggett puts it, by pre­vent­ing Medi­care from pay­ing more than the av­er­age price in coun­tries that re­sem­ble the United States eco­nom­i­cally.

That pro­vi­sion re­sem­bles an elec­tion-eve plan spelled out by Trump that raised eye­brows given his crit­i­cisms of health care sys­tems in for­eign lands.

Call­ing it a “rev­o­lu­tion­ary change,” the pres­i­dent an­nounced Oct. 25 that an “in­ter­na­tional pric­ing in­dex” will be used in a demon­stra­tion pro­ject to de­ter­mine how much will be paid for drugs cov­ered by Medi­care Part B — the orig­i­nal Medi­care part that cov­ers ser­vices and sup­plies.

Trump’s pro­posal wouldn’t take ef­fect for more than a year, and only as a demon­stra­tion pro­ject, rather than a reg­u­la­tion that pre­scribes poli­cies.

None­the­less, it gen­er­ated cries of “price con­trols” from the Phar­ma­ceu­ti­cal Re­search and Man­u­fac­tur­ers of Amer­ica (PhRMA), the in­dus­try’s trade group in Washington.

The in­dus­try is cer­tain to wage an all-out ef­fort against the Doggett plan.

PhRMA has spent $21.8 mil­lion this year on lob­by­ing, about 10 per­cent of the $216 mil­lion lob­by­ing ex­pen­di­tures of the pharma- ceu­ti­cal and health prod­ucts in­dus­try, ac­cord­ing to the Cen­ter for Re­spon­sive Pol­i­tics.

A PhRMA spokes­woman, Holly Camp­bell, said by email that “we can’t spec­u­late on what Congress may or may not do, but we re­main fo­cused on ad­vanc­ing mar­ket­based re­forms” that lower costs.

She added that medicine prices in­creased just 1.9 per­cent last year, even though pa­tients’ outof-pocket costs con­tinue to rise.

Dan Men­del­son, a con­sul­tant who over­saw health care is­sues in the Clin­ton ad­min­is­tra­tion’s Of­fice of Man­age­ment and Bud­get, sees a dif­fi­cult road for the Doggett bill.

More likely, he said, are mod­est changes aimed at boost­ing com­pe­ti­tion among drug­mak­ers and re­quir­ing more trans­parency in how they set prices.

“There is not con­sen­sus about the gov­ern­ment setting lim­its on the cost of drugs and there is not con­sen­sus that gov­ern­ment can do bet­ter than the pri­vate sec­tor in ne­go­ti­at­ing the cost of drugs,” he said.

Men­del­son also sees the elec­toral pol­i­tics play­ing a role as Democrats lay the ground­work for wrest­ing the White House from Trump in 2020.

“They’re not go­ing to want to put the ques­tion to bed,” he said, re­fer­ring to the like­li­hood of drug prices re­main­ing a po­tent cam­paign is­sue in two years.

Dr. Walid Gel­lad, di­rec­tor of the Cen­ter for Phar­ma­ceu­ti­cal Pol­icy and Pre­scrib­ing at the Univer­sity of Pitts­burgh, is less cer­tain that Doggett faces in­sur­mount­able odds.

“A lot of peo­ple are writ­ing it off. I’m not so sure I would do that,” he said. “It would have a lot of trou­ble in the Se­nate. But you never re­ally know these days with this ad­min­is­tra­tion and what might hap­pen in a deal.”

Ron Cortes / Con­trib­u­tor

U.S. Rep. Lloyd Doggett, cen­ter, and his fel­low House Democrats aim to move quickly on the is­sue of drug prices.

Ron Cortes / Con­trib­u­tor

Alexan­dria Gar­cia talks with state Rep. Diego Ber­nal, from left, U.S. Rep. Lloyd Do­gett and state Sen. Jose Me­len­dez about the prob­lems she’s had with the price of pre­scrip­tion drugs.

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