For months Congress has been debating massive changes to the nation’s social safety net, one of which is the highly popular Medicare prescription drug benefit. Unfortunately, much of what is being debated around that benefit today loses sight of the real barriers to a better health care system. It is a fact that too often, accessing medical treatment in the United States is harder than it should be. Today, three in 10 Americans face financial barriers to care – and that’s Americans with health insurance. Access hurdles exist throughout the health care system, including doctors’ visits, hospitals, insurance premiums and deductibles and, yes, medicines.
Congress is absolutely right to address these issues, as no one should have trouble accessing the care they need, especially not in a country like the United States. What’s unfortunate is the debates happening on Capitol Hill seem to have lost sight of the bigger picture and are not addressing the real drivers of patient angst. By proposing draconian policies that would dramatically increase government involvement within the health care system, some members of Congress risk not only making health care access issues worse, but also isolating voters who have voiced clear concerns around policies like H.R. 3. The most recent drug pricing proposal in the Build Back Better legislation ignores those concerns and will create a system where one person – a government official – will have the unprecedented authority to determine the value of a medicine. This will inevitably lead to access restrictions for seniors.
Patient Access to Medicines
Let’s take access to medicines. More medicines are available in the United States than any other country, and yet 41% of U.S. patients last year did not take their medicines as prescribed, whether through pill splitting or not filling their prescription at all. This duality stems from myriad factors, including out-of-pocket costs that have risen substantially for many patients in recent years. Unfortunately, many proposals in Congress do not address the underlying incentives that drive access and affordability challenges in the U.S. Rather, these policies presume government price-setting could be a silver bullet – a dogmatic position that may sound reasonable without any context, but proves unworkable as soon as we examine the broader landscape.
The insulin market is a great example. If we account for the rebates and discounts that health insurance companies and pharmacy benefit managers (PBMs) receive from insulin manufacturers, net prices for the most commonly used insulins have gone down by 40-50% since 2014. But because these savings are not always directly shared with patients, it often doesn’t feel that way. Instead, as health insurers shift more financial responsibility onto patients in the form of higher deductibles and coinsurance, people with chronic conditions like diabetes face higher out-of-pocket costs, effectively subsidizing the healthy. That’s not how insurance is supposed to work! To help address these challenges, two of our members recently launched generic versions of their insulins. But both have struggled with uptake, in part because some insurers chose not to cover them. Excluding lower cost options for patients may be a byproduct of incentives in our current system, which policymakers and experts have noted can lead health plans and PBMs to favor medicines with high list prices and large rebates.
Beyond failing to address the broader drivers of affordability challenges, government price-setting policies like that in the Build Back Better plan are not even what voters want. Recent polling shows that once you inform people that draconian price-setting policies will necessarily reduce access to treatments – and jeopardize the development of future ones – they realize it’s not worth the tradeoff. When told that Medicare “negotiation” could limit people’s access to newer prescription medicines, initial support plummets from 63% to 14%, according to a new Ipsos/PhRMA poll. The same poll showed that when given the choice, 77% of voters say Congress should focus more on reducing the overall costs of health care coverage, such as premiums, deductibles and copays, versus the list prices of prescription medicines (22%).
Study after study (after study) indicates that government price-setting policies would result in fewer medicines coming to market due to reduced investment in R&D – with life-threatening consequences. Those lost medicines could include critical future treatments and cures that would never make it to patients.
A Better Way
As a lifelong Democrat, the current debate in Congress is truly disappointing. So many Americans have raised concerns over price-setting policies, and these concerns seem to fall on deaf ears. Rather than take time to develop thoughtful policies that solve the real issues voters are facing, policymakers have chosen to focus on dogma and soundbites. Without addressing the ecosystem and the cost drivers that really stand in the way of patient affordability, we won’t truly help patients.
We’ve proposed a list of patient-centered solutions that would more effectively help people afford their treatments by addressing the broad, fundamental problems in our health care system. It’s up to those in Congress whether they want to listen.