Remember back in May when President Donald Trump announced his blueprint for cutting drug prices?
While most people think of a blueprint as a carefully designed plan, the administration’s document, which is easy to find with a quick internet search, is a potpourri of many notions. They’re the types of suggestions we’ve all heard shouted out in brainstorming sessions as a harried moderator struggles to capture every utterance on a whiteboard.
Brainstorming works only if you later sift through the mountain of random ideas to find one or two useful nuggets. The remaining 90% is tossed. Regrettably, the president’s blueprint appears to be stuffed with ill-conceived, impractical, and even silly ideas.
Here’s an example. Lower drug prices by streamlining the approval of prescription to OTC conversions. Really? Which therapeutic categories are we talking about — diabetes, oncology, or hypertension? Drugs for these conditions are already generic and cheap.
Besides, experience with NSAIDs, allergy meds, and proton pump inhibitors has shown any OTC version of these drugs will cost far more than the prescription versions covered by insurance.
How about this idea? Force manufacturers to include prescription drug prices in their DTC ads to encourage competition. Great. As if the existing fair balance requirements aren’t confusing enough.
Besides, what is the patient supposed to do with the info that drug X costs $Y? What is the physician supposed to do — look for something cheaper?
Most of the president’s proposals were criticized when they first appeared and probably would have been forgotten. But all bets are off after the November midterm elections. The re-empowered Democrats have their own agenda for controlling drug prices.
This year we’ll be hearing about Medicare for all, even though no one is sure what it means. Will all citizens have access to Medicare Advantage plans or will we be looking at a single-payer program run by the federal government? House Speaker Nancy Pelosi will undoubtedly enlighten us soon.
At the same time, we’ll surely see a renewed push to allow Medicare to negotiate directly with manufacturers, which has been touted for decades as a cost-cutting cure-all. Proponents will point to the lower drug prices paid by the Veterans Administration and laud the discounts exacted by foreign healthcare programs such as Britain’s NICE.
Economists will counter this approach will work only if Medicare is willing to say: “If you don’t lower your price, we won’t cover your drug.” Is that tenable in the U.S.? Are we ready to legislate how much a life-saving drug should cost?
How these big ideas will pan out is anybody’s guess. Senators won’t welcome legislation that strengthens either the Affordable Care Act or Medicare. And although Trump favored allowing Medicare to negotiate directly with manufacturers during his campaign, he backed down after encountering conservative opposition.
Even if legislation doesn’t make it to — or past — the president’s desk, remember that in the eyes of many voters and on the pages of The New York Times and The Wall Street Journal, pharma is still a price-gouging villain.
Campaign promises must be addressed. A regulation mandating prices in DTC ads or a directive to the FDA to speed up prescription to OTC conversions may be tough for Congress to resist. Stay tuned. The blueprint may not yet be dead.