Healthcare was a key issue for voters in the split-decision midterm elections. So are we in for more partisan divide and no progress? Not necessarily. We simply need to reframe the debate to find common ground.
The Democrat-controlled House won’t consider Obamacare repeal, and the Republican Senate won’t consider Medicare for all. But there are ways to make constructive changes without relying on ideologically charged policies which can’t advance in this environment.
There’s widespread agreement that patients should pay less for prescription drugs. Even as innovative drugs prevent or slow the progression of disease and reduce expenses such as hospital costs, patients and politicians alike are clamoring for lower drug prices.
Many on the Left seek to wave a magic wand and lower prices through government intervention with little regard to how this would discourage life-saving and money-saving innovation. Last month, even the Trump administration proposed dusting off an old and innovation-killing approach which would base some prices paid by Medicare on what other countries pay.
Meanwhile, legislators on the Right who ignore the prices their constituents pay for drugs risk losing their own congressional healthcare plan after their next election. Yet addressing the issue doesn’t require abandoning principles.
While there’s no one magic bullet that would make prescription drugs more affordable for patients, there has been increased scrutiny of the role of middle men known as pharmacy benefit managers. PBMs themselves have rapidly evolving incentives. No longer are they simply independent price-negotiators. Following two recent mergers, all major PBMs are now part of the health insurance industry.
J.C. Scott, the new president of the Pharmaceutical Care Management Association, the PBM industry’s trade group, recently told Politico’s Prescription Pulse that his top priority was simply making sure that people understand what pharmacy benefit managers do.
So what do they do? When PBMs negotiate on behalf of insurance companies, are they playing a crucial role in containing medical costs for patients? Or are they so conflicted, because they take a share of rebates offered by pharmaceutical companies, that they are incentivized to keep prices high?
To know, we’ll need more transparency through the entire supply chain, to show whether consumers are in fact benefiting from PBM’s negotiations.
Lawmakers across the country have begun addressing the lack of transparency around PBMs and its effects on patients. Sens. Elizabeth Warren, D-Mass, and Tina Smith, D-Minn., sent lettersto nine PBMs to determine how they are approaching drug pricing rebates. This probe is accompanying more than 90 bills nationwide that are focused on PBMs and their opaque role in the drug supply chain.
Time will tell if patients will actually see the savings that PBMs supposedly generate. The three largest PBMs, all linked to insurers, collectively control nearly 80 percent of the market, meaning that millions of Americans are affected by the decisions they make in negotiating prices for various drugs. Will pharmaceutical price-reductions lead to lower prices for patients? We’ll need transparency from PBMs and health insurers to understand how a reduction in what pharmaceutical companies charge for a drug translates into lower costs for patients at the pharmacy.
PBMs’ defenders maintain that drug prices would be even higher without their role as go-betweens. The recent dramatic price cuts for some drugs put that idea to the test. PBMs can prove their value — or lack thereof — by moving quickly to pass these price reductions along to patients.
Surely, drug companies seeking to remove the targets from their backs in exchange for lowering drug prices will be watching the PBMs’ next moves very closely. So should consumers.