Much of the stakeholder reaction to healthcare initiatives in President Joe Biden’s State of the Union address on Tuesday centered on the president’s repeated urging to Congress to allow Medicare to negotiate drug prices.
“That is why my top priority is getting prices under control,” Biden said Tuesday night. “We pay more for the same drug produced by the same company than any other country in the world.”
Biden put the spotlight on insulin, which he said costs about $10 a vial to make. But drugmakers charge 30 times that amount, said Biden, who wants to cap the cost of insulin at $35 a month.
WHY THIS MATTERS: REACTION
PhRMA countered that insulins are less expensive today than in 2007. Citing data from the Bureau of Labor Statistics, the Pharmaceutical Research and Manufacturers of America said prescription drug prices rose just 1.3% over the last year.
PhRMA President and CEO Stephen J. Ubl said, “We urge President Biden and Congress to work on a holistic solution that fixes what’s broken in our healthcare system. Allowing the government to set the price of medicines isn’t the answer. We know that story will end with less access to medicines and less future innovation, and we know there’s a better way.”
This includes solutions that “address abusive practices within the insurance system,” Ubl said, referring to out-of-pocket costs for consumers.
AHIP President and CEO Matt Eyles said, “The President is right: Drug prices are out of control, particularly for insulin, which is lifesaving for millions of Americans. But we must hold drug manufacturers accountable and not give them a free pass to raise insulin prices every single year. Imposing copay caps that do nothing to address underlying prices set and controlled by manufacturers will not help consumers and American businesses – they would only end up paying for those caps through higher insurance premiums and copays.”
The Campaign for Sustainable Rx Pricing (CSRxP) said it supports imposing a cap on out-of-pocket costs for Medicare Part D beneficiaries.
“CSRxP commends President Biden for continuing to recognize out-of-control prescription drug prices are a top concern facing the nation,” said CSRxP Executive Director Lauren Aronson. “Now, Congress must finally deliver on repeated promises to lower drug prices with market-based solutions that hold Big Pharma accountable and deliver relief for the American people.
“The American public is watching closely, ahead of the midterm elections later this year, to see if lawmakers will meet the moment to deliver relief for the millions of families who experience financial hardship affording their medications,” Aronson continued.
Attorneys at Hagens Berman representing insulin purchasers in a class-action lawsuit against the big three insulin makers – Sanofi, Novo Nordisk and Eli Lilly – said they filed a motion for class certification on the same evening President Biden highlighted insulin price hikes in his State of the Union.
The lawsuit filed in 2017 in the U.S. District Court for the District of New Jersey claims the systematic overpricing of insulin has resulted in patients resorting to extreme measures to survive rising prices, such as starvation to control their blood sugar, intentionally slipping into diabetic ketoacidosis to receive insulin samples from hospital emergency rooms, under-dosing insulin and taking expired insulin. Some plaintiffs now pay almost $900 per month just to obtain the drugs they need, according to the firm.
THE LARGER TREND
Research, funded by the Robert Wood Johnson Foundation and prepared by the Urban Institute, finds a proposal to cap out-of-pocket expenses in Medicare would lower prescription drug prices by an average of $900 for eligible Part D enrollees. A $2,000 cap on prescription drug out-of-pocket costs for Medicare Part D enrollees who do not qualify for cost-sharing protections would save more than 860,000 enrollees an average of $900 annually. The proposal would increase Medicare spending by less than 1%.