Recently, politicians from both sides of the aisle have proposed plans to solve patients’ out-of-pocket spending issues.
Unfortunately, a number of them raise significant concerns over a patient’s ability to access the prescription drugs and treatments they so desperately need. While I know firsthand that government programs need to be updated and improved to keep up with modern-day medicine, proposals such as the newly introduced H.R. 3 contain particular changes that could harm patients more than they would help.
The proposal’s use of international reference pricing is of particular concern as many of the countries listed as reference points (Canada, France, United Kingdom, Germany, Australia and Japan) experience substantial barriers to accessing care. Under H.R. 3, the government would set U.S. drug prices and determine coverage based off the average prices found in these reference countries. However, the proposal fails to highlight that many of the drugs available to American patients are not found abroad.
In fact, of 74 cancer drugs that launched between 2011 and 2018, the United States had access to 95 percent of them compared to just 74 percent in the U.K. and only 49 percent in Japan. And for the cancer drugs available in five of the reference countries, there is often a 15-month lag between the time U.S. patients can access them and when they are available in those other countries.
Instituting international reference pricing would also upend the foundation of the Medicare Part D program. As one of the original senators involved in the implementation of Medicare Part D, I believe its creation symbolized a transformative approach to how Americans, particularly seniors, view their health care.
Under the current program, seniors do not have to question access to the broad array of medications that Part D provides. This allows doctors and patients to focus more on tailoring a health plan based off their needs rather than based off their ability to access certain care. Drastic changes to Medicare and our larger health care system will undermine its many successes and ultimately hurt the integrity of a program created uniquely to prioritize prescription drug access for its 45 million beneficiaries.
Furthermore, changes to how drug prices are negotiated and what drugs are available in both the private and public markets will inevitably ripple throughout our health care system, leading to a potential decline in medical advancements. Patient health is too important to gamble with, and allowing proposals that undermine already successful programs and take aim at medical innovation would be naïve.
I am optimistic, however, about some changes under consideration that take a different approach to lowering costs for patients. The current prescription drug rebate system — while flawed — already provides significant discounts on drugs.
Unfortunately, middlemen known as pharmacy benefit managers often pocket the savings those rebates produce rather than funneling it through to the patients who need it. Reforming the system to ensure PBMs pass on those savings directly to patients will lower patient out-of-pocket costs at the pharmacy counter and increase transparency within the rebate distribution system.
Additionally, establishing an out-of-pocket cap on patient spending is a commonsense approach that is included in a few proposals and should be backed by both sides of the aisle. Caps on cost would allow patients to better financially plan for the future and maintain good health — reining in costs for the entire health care system.
Health care is personal, which makes it difficult to change and regulate. However, I am encouraging lawmakers to put politics aside — as we did in 2003 with the creation of the Part D program — and look at the facts.
Americans want access to the drugs they depend on each and every day. If they have a critical disease with no current cure, they want to believe a cure is in the future.
Any changes to drug pricing that limit access and discourage the research and development of more effective treatments are short-sighted and will ultimately hurt patients. If we want our children and grandchildren’s health care to be better than our own, then we must stay true to our commitments and never sacrifice access to the high-quality medical care that Americans deserve.
Blanche Lincoln served as a Democratic senator from Arkansas from 1999 to 2011, and she is the founder and a principal of the Lincoln Policy Group, a governmental affairs consulting firm that serves a wide range of clients and offers specialized federal health care policy analysis and advocacy.
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