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Jim Kenyon: Containing prescription costs may hinge on politics

  • A bill for Art Pistey’s infusion treatment shows the $178,750 charge for the drug.

Valley News Columnist
Published: 2/8/2020 10:24:05 PM
Modified: 2/8/2020 10:29:08 PM

For the last year, Democratic presidential candidates crisscrossing New Hampshire ahead of Tuesday’s primary have talked a lot about reining in prescription drug prices.

Whether the talk progresses into policy hinges largely on who occupies the White House and which party controls Congress after the 2020 election.

In December, the House passed a bill that would allow the federal government to negotiate prices for prescription drugs.

Private insurers already negotiate prices with drug makers, but Congress doesn’t allow Medicare to do the same.

Under the bill, the lower prices would apply to patients on private insurance and millions of Medicare recipients.

The measure, which has long been a priority of progressive Democrats, passed largely along party lines. Only two Republicans supported the bill, known as the Elijah Cummings Lower Drug Costs Now Act, named for the late Democratic congressman from Maryland.

The proposal appears doomed in the Republican-led Senate, however. Senate Majority Leader Mitch McConnell, of Kentucky, has called it a “socialist” measure.

During the 2016 presidential campaign, Donald Trump said Medicare should negotiate prices directly with drug manufacturers, but dropped the idea after taking office.

Over the years, the pharmaceutical industry has blocked attempts to impose what is often described as “price controls.”

“Big Pharma” is a force like no other industry that lobbies in Washington. The pharmaceutical industry spent nearly $130 million on lobbying — more than any other industry — during the first nine months of 2019, the Center for Responsive Politics reported in October.

“That spending comes on top of the industry’s many ad campaigns designed to influence lawmakers and the general public,” the nonprofit research group wrote on its website,

Juliette Cubanski is associate director of the Program on Medicare Policy at the Kaiser Family Foundation, a nonprofit that focuses on national health issues.

“Manufacturers basically set prices where they want them to be without any real justification,” she said in a phone interview.

In December 2018, Aaron Kesselhelm, a Harvard Medical School professor, told The New York Times, “A key disadvantage of Medicare’s drug benefit is that it has no real system in place for holding down drug prices. Drug manufacturers with monopoly products can raise prices to whatever extent the market will bear.”

Unlike private insurers, Medicare “can’t walk away from the table” and refuse to cover a drug, he added.

Medicare’s prescription drug program is divided into two parts. Medicare Part D covers medications that people pick up at a pharmacy or have delivered to their door.

Medicare Part B tends to cover the most costly drugs, such as those used in treating cancer, that are administered in a doctor’s office or a hospital setting.

Under the bill that passed the House, the secretary of Health and Human Services could negotiate lower prices for 50 to 250 drugs a year.

But even if the bill advances, it’s unclear how many of those drugs would come from the Medicare Part B category. That worries people such as Art Pistey, of Canaan.

Pistey, a 66-year-old chiropractor, takes Ocrevus, a costly Medicare Part B drug, to combat multiple sclerosis.

Last year, Medicare paid $80,581 for one dose of Ocrevus that Pistey received during a daylong infusion at Alice Peck Day Memorial Hospital in Lebanon. He was still left with a bill of $35,750, but those out-of-pocket costs were covered by his private supplemental insurance policy.

Pistey wonders what might happen, however, if costly drugs such as Ocrevus are not part of the government’s price negotiations. Will the drug maker raise the price higher? If so, will his private supplemental insurance continue to pick up his out-of-pocket costs?

“We have to do something about the drug companies, but they’re so powerful,” Pistey said.

Drug manufacturers argue that price controls will lead to less research and development of new ground-breaking drugs that improve and save lives.

“It’s hard to know how much innovation we’ll lose, but nobody wants to put it to the test,” Cubanski said.

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