WASHINGTON -- The Trump administration is going to need help from Congress if it wants to lower prescription drug prices, an aide to House Speaker Nancy Pelosi (D-Calif.) said here Tuesday.
"The administration wants to lower prescription drug prices, and so far they've tried to do that on their own, and I just don't think that's going to work," Wendell Primus, PhD, said at a conference sponsored by AcademyHealth. Last Thursday, the administration proposed a rule that would eliminate a regulatory exemption in the Medicare and Medicaid programs for rebates to insurers and pharmacy benefit managers (PBMs), and "I think they have the authority to do that, but the question is, how does that market respond?"
Under the proposal, "the Office of the Actuary assumed list prices would go down a little bit but actually net prices would go up," he continued. "And as a result, the Office of the Actuary said, drug spending is going to increase by $137 billion and the taxpayers are going to actually get hit for another $200 billion or so in the Part D program."
Other analyses have questioned that conclusion a little, "but the point is, there is no authority the secretary can use to hold down prescription drug prices," Primus said. "The Democrats on the Hill want to work with this administration; I think a deal is possible. And there's many advantages to working together. Pharma will be out saying 'you take away our incentive to find cures, innovation' but if both parties work together, I think that argument goes away."
Katie Meyer, of the Office of House Minority Leader Kevin McCarthy (R-Calif.), agreed that "we have a drug pricing problem in this country and we do need to address it." However, "Republicans want to make sure changes don't have unintended consequences," added Meyer, who was speaking for herself. "America does lead the world in research and innovation ... We need to make sure that doesn't stop."
"Surprise billing," in which patients who get care at in-network hospitals receive unexpected bills for hospital clinicians that aren't in their network, are another area of potential cooperation, she said. "Republicans do want to help people who are facing these high medical costs."
But despite the talk of harmony, the conference also showed the deep divisions that still remain in Congress. "We will have oversight hearings as to what is happening in these areas," said Rep. Rosa DeLauro (D-Conn.), chairwoman of the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. "One area that's particularly important to all of you is what is the impact of the administration's policies on the Affordable Care Act (ACA)? Let's take a hard look at that."
"I'm alarmed ... about the administration's work to undermine the ACA," she said, referring to actions by the Department of Health and Human Services to shorten the open enrollment period and decrease funding for advertising the ACA's health insurance exchanges and for "navigators" to help people sign up for insurance. "To that end, tomorrow morning, we're hosting a hearing about this effort."
Primus and Meyer also sparred about the individual mandate -- the ACA requirement that everyone have health insurance or pay a penalty -- that was eliminated as part of the Tax Cuts and Jobs Act. In response to a question from the audience, Meyer noted that the Republicans do have an alternative to the mandate: a requirement for continuous insurance coverage. "That [alternative] was demagogued and is still being demagogued as undermining protections for people with preexisting conditions," she said. "But it's something we're open to talking about."
Primus contended that Americans didn't have a problem with the mandate. "Americans have [already] dealt with requirements to buy insurance," such as auto insurance or homeowner's insurance, he said. "The individual mandate is important -- we saw New Jersey reinstate it and California [may also] ... You shouldn't have to pay for my hospital bill."
At another panel, James Capretta, resident fellow at the American Enterprise Institute, a right-leaning think tank here, noted that the Graham-Cassidy bill, which would have given states block grants to help state residents pay for healthcare, is not likely to re-emerge as a viable alternative to the ACA. "If this was going to be the next great way to repeal and replace the ACA, it would have happened already," he said. "When push comes to shove, the coalition in support of this will narrow, and it probably wouldn't pass."
"The problem is not that states haven't been given sufficient control to run everything themselves," he added. "The problem is that the markets that were set up are not strong enough; there's not enough competition. The fundamental problem with American healthcare is that it's too inefficient; there's a lot of money spent that's wasteful."
"If we want to try a market-based approach to fixing healthcare, we should have a market-based approach to fixing healthcare, and Graham-Cassidy is not that," he said. "If Republicans are serious about trying to have a market-based health system, they need to be much more proactive in that direction."
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