As some in Washington consider legislation related to prescription medicines and how to best help Americans manage health care costs, government “negotiation” of prescription medicines within Medicare continues to be debated. The concept of government-led negotiation is highly misleading – and there are other, more common-sense policy solutions that are in the better interest of patients. Here, we dig into the top myths and facts surrounding Medicare negotiation.
Myth: Americans support government negotiation in Medicare under any circumstances.
Fact: Data shows that once Americans understand what government negotiation is, and the tradeoffs involved, they reject it. According to the Kaiser Family Foundation, 65% of Americans oppose negotiation if it leads to less research and development of new treatments or if it limits people’s access to medicines once they come to market. Additional data reveals that 72% of Americans actively oppose government negotiation if it results in fewer new medicines being developed in the future, and 76% of Americans oppose government negotiation if it causes delay in access to new prescription medicines.
Myth: Government-led negotiation will help patients and won’t reduce access.
Fact: When policymakers propose that the government negotiate prescription medicine prices in Medicare, it’s accompanied by a harsh reality: reduced access to prescription medicines and choices for patients. In fact, independent analysis from the Congressional Budget Office (CBO) has consistently said that the only way for the government to negotiate a better deal is to limit access and choice of medicines for patients. This is despite the fact that, according to recent data, nearly 9 of every 10 Medicare beneficiaries enrolled in Part D prescription drug plans say they are satisfied with their medication coverage.
Myth: Americans want to upend the entire health care system at all costs.
Fact: After seeing first-hand the power of innovation through the development of COVID-19 vaccines and treatments, Americans do not want to throw the U.S. health care system into chaos. In fact, 79% think that we need to be cautious about changes we make to the stressed health care system coming out of COVID-19. Additionally, recent data found 71% oppose allowing the federal government to interfere in negotiations between Medicare Part D plans and drug manufacturers if it means seniors and those with disabilities could lose access to the medicines they currently take.
Yet implementing Medicare “negotiation” would bring about significant changes that lead to upending the health care system, starting with having to repeal a provision in the law that prohibits the Secretary of Health and Human Services from interfering in the private negotiations that occur between pharmaceutical manufacturers and Part D insurance plans or pharmacy benefit managers (PBMs). If this protection goes away, it leaves a void in which unintended consequences could follow, leaving seniors and people with disabilities who count on Medicare for access to vital medicines severely impacted. In fact, recent data found that 84% of seniors are concerned Medicare “negotiation” would lead to reduced choice and options about which prescription drugs they can get, and 82% are concerned it could lead to a benefit cut for seniors and people with disabilities.
Myth: Medicare negotiation is the best solution to lower prescription drug costs.
Fact: Simply put, Americans have real concerns about radical changes to the health care system and the tradeoffs that more government involvement in negotiation brings. However, there are commonsense, voter-supported solutions for those who pay too much for their medicines at the pharmacy, such as:
- Capping how much people have to pay out of pocket for medicines in Medicare Part D.
- Ensuring discounts biopharmaceutical manufacturers already negotiate with health plans and PBMs get passed along to seniors and people with disabilities at the pharmacy.
- Allowing seniors with high out-of-pocket spending to spread out their payments over the year so they have more predictable costs month-to-month.
There are steps we can take to lower patients’ out-of-pocket costs that protect access to medicines and helps make our health care system more secure. But we can only achieve that through commonsense, bipartisan solutions – not Medicare “negotiation.”
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Tom Wilbur is Director of Public Affairs at PhRMA focusing on message development and opinion research. Prior to joining PhRMA in 2019, Tom worked on Capitol Hill and on political campaigns for nearly a decade, most recently responsible for communications, campaigns and strategy for U.S. Rep. Fred Upton and the House Energy and Commerce Committee. Tom is a proud Michigander and outside of the virtual office enjoys reading, running, hiking, golfing, and spending time with friends and family.