The Political Parameters of Drug Prices
By Gabriel Levitt, Chair, Prescription Justice
When it comes to improving healthcare in America, solutions to end the crisis of high drug prices have the most bi-partisan promise. And that’s what Prescription Justice is all about. As chairperson of this organization and someone following this issue for almost 20 years, I’m going to give you my opinion of the politics of the situation as this year kicks off.
Before diving in, I want to let you know that our Board will give you the Democrat and Republican perspectives on this blog. Democrat Colleen Kenny published “New Administration, New Democratic Majority, New Progress on Drug Prices?” Republican Board president Lindsay Brown published “Is GOP Action on Drug Prices At a Standstill?”
The laser focus of our government is rightfully on efforts to end the pandemic’s terrible death toll and vastly reduce sickness from Covid-19, provide economic safety nets for those most in need and stimulus to prevent permanent damage to the economy. Our leaders must not wait a moment longer than necessary, however, to pass legislation and push regulatory reforms necessary to bring down drug prices quickly. With about 30% of Americans not filling prescriptions as directed, an estimated 100 million people, we can’t afford to wait.
Our board of directors holds an array of political and policy ideas – and disagree on many issues. Not so when it comes to drug prices. We agree that the pharmaceutical industry’s intense lobbying and campaign contributions to Congress are the problem and political transparency is a big part of the solution. That’s why we created the Congressional Report Card on Drug Prices. We want as many people as possible to know who the greatest champions in Congress are working to lower drug prices and who are those doing the bidding of their drug company campaign donors.
Yes, Democrats have better grades than Republicans from 2020. It’s glaringly the case. I’m a lifelong Democrat, and Liberal to boot, but I’m skeptical of my own party’s commitment to this issue. I explain below as I also sum up last year and how it bleeds into this year.
Last year we used three bills as part of our methodology for grading members of the House. The other variable for grading included bill sponsorship and co-sponsorship, donations from drug companies, and policy stances on congressional websites. The bill with the most points attached to it was H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, which passed. The vote was 230-198. Democrats unanimously voted yes for 228 votes; two Republicans joined them. That’s how it goes with many bills. The Parties close ranks and partisanship reigns. I strongly supported this bill because it contained strong reforms to lower drug prices, specifically allowing for the federal government to negotiate drug prices in Medicare. However, my fellow Democrats knew that then Senate leader Mitch McConnell would never bring it to vote. It was an easy vote for Democrats, even ones with a history of supporting Big Pharma. With full control of government, let’s see if that unity holds.
From the Republican side, Chuck Grassley (R-IA) reintroduced the Prescription Drug Pricing Reduction Act of 2020 (S. 4199). This bill contained provisions that were worked out with Sen. Ron Wyden (D-OR) in 2019 and initially applauded as a bipartisan effort by organizations including AARP, Patients for Affordable Drugs and the Campaign for Sustainable Drug Pricing. Last summer, Sen. Wyden and other Democrats on the Finance Committee who voted yes in committee in 2019 did not renew that support. Finger pointing ensued. Grassley accused Wyden of walking away from the table for political purposes; Wyden countered that the Republicans were never at the table because their leader, Sen. McConnell would not bring drug price legislation to a vote at all.
Does H.R. 3 and S. 4199 have anything in common? Yes. They both would substantially lower out-of-pocket spending in Medicare Part D; shift cost liability in Medicare Part D from the government to insurance companies and drug companies would share some of those costs. Also, both bills aim to keep drug price increases at the rate of inflation.
Those points of agreement are worthy of note but not enough to substantially tackle the drug price crises. Only through allowing negotiation by the federal government on drug prices or employing international reference pricing and allowing safe prescription drug importation will we get to the heart of the matter: astronomical list prices by Big Pharma. That’s why those policies are fundamental to our platform. With University of Michigan Emeritus Professor of Economics Stephen Salant, I co-authored an op-ed in The Hill explaining the power of these policies: see The one-two punch to knock out high drug prices.
President Joe Biden’s campaign policy platform on drug prices included support for Medicare drug price negotiations and drug importation. With control over the House and Senate, there’s no excuse not to move these policies forward. The Senate rules requiring 60 votes are an obstacle. It’s also the perfect opportunity to show that we can come together as a country on the issue of drug prices. Republican voters overwhelmingly support Medicare drug price negotiations and importation of lower cost drugs, 80% and 76%, respectively. Those voters can help get 10 Republicans in the Senate to get on board.
We’ll be trying to help them!