By Jane Gilbert
February 4, 2019 at 5:00 am ET
More than two-thirds of Americans report that they are very concerned about the high cost of prescription drugs. So, as eyes turn to this week’s State of the Union and the 116th Congress focuses on its work in Washington, drug pricing undoubtedly will be a top priority for lawmakers who are looking to create meaningful change for patients.
As steward of retiree health care for the Teachers’ Retirement System of the State of Kentucky, I help ensure the integrity of the retirement benefits for more than 48,000 of our state’s former teachers. Our voice — and that of other purchasers who provide health care and drug benefits to millions of other Americans — sometimes is lost in the noise around the drug pricing debate in Washington.
The teachers I work on behalf of paid into this retirement system throughout their careers, and it’s my job to do everything possible to see that these benefits are there for them in their retirement years. This includes their access to affordable, quality health care, including their prescription drugs.
However, my job has become increasingly difficult as drug prices continue to rise with no end in sight. Recent studies show that over the last five years, the price of the 20 most prescribed drugs to seniors increased by an average of 12 percent each year — outpacing the average annual rate of inflation by 10 times. These rising drug prices have dire effects not just for retired teachers in Kentucky, but for retired Medicare beneficiaries across the country with fixed incomes.
To help manage retirees’ costs in the face of ever-rising drug prices, TRS relies on pharmacy benefit managers to negotiate with drug manufacturers and drive down the prices of prescription drugs through both discounts and rebates. The PBM that TRS partners with helps TRS keep prescription drug costs in check by ensuring our retirees have access to lower-cost generic alternatives and by providing patient-focused programs and tools, such as medication management tools for chronic conditions of diabetes and heart disease. Eliminating rebates in Medicare Part D is a distraction from the real problem. The real problem is the drug list price that is not established by PBMs.
These programs and tools are critical to keeping TRS’ health care costs from increasing at an unsustainable rate while also improving health outcomes and avoiding unnecessary, significant medical costs such as hospital admissions due to adverse drug events. TRS’ PBM works hard to keep health care and drug costs affordable for Kentucky’s retired teachers. In fact, PBMs are expected to save Kentucky patients and health care purchasers $9.4 billion over the next 10 years.
As policymakers in Washington look for ways to ease the burden of high drug prices on patients and their families, solutions should be found that expand and enhance the tools PBMs use on behalf of purchasers and patients and increase timely competition to improve access. Congress should focus on public/private partnerships, other market-based or federal solutions that will put downward pressure on the rising prescription drug prices set by drug companies and preserve affordable options for patients.
Retired Kentucky teachers, who dedicated their lives to educating future generations, shouldn’t have to choose between paying for the prescription drugs they need to get to stay healthy and putting food on their tables. The stakes are too high to get this wrong.
Jane Gilbert is the director for retiree health care for the Teachers’ Retirement System of the State of Kentucky, which represents more than 120,000 active and retired teachers in the state of Kentucky.
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