Legislators Want Medicare to Negotiate Drug Prices to Improve Access and Affordability

November 18, 2021 by Alec Stone MA, MPA, Former ONS Director of Government Affairs and Advocacy

Note. Copyright Senate Democrats. Used under the Creative Commons Attribution 2.0 Generic (https://creativecommons.org/licenses/by/2.0/deed.en).

Few political and policy issues resonate with all Americans as much as the costs of prescription medications, particularly those for acute and chronic diseases that affect the body and spirit, like cancer. Seizing the opportunity for real change, in August 2021 President Joe Biden made a major announcement about his administration’s intent to change the dynamic on the financial impact of drugs and government oversight.

Right now, right here in America, we pay the highest prescription drug costs of any developed nation in the world. These prices have put the squeeze on too many families and stripped them of their dignity. We force people into terrible choices, between maintaining their health, paying the rent or the mortgage, putting food on the table. Today, one in four Americans who take prescription drugs struggles to afford them. Nearly 30% have skipped doses or cut pills in half because they can’t afford the cost. We have to change (https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/08/12/remarks-by-president-biden-on-how-his-build-back-better-agenda-will-lower-prescription-drug-prices/) this, and we can.

President Joe Biden

The Problem With Pricing

Before COVID-19 overtook health policy, the U.S. Congress began bipartisan, bicameral hearings on drug pricing. In particular, politicians are eager to begin a conversation (https://sgp.fas.org/crs/misc/IF10830.pdf) focusing on older adults and Medicare’s 58 million enrollees. And so are their constituents: an overwhelming 88% of those surveyed support (https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/) the federal government’s need to negotiate drug prices, especially for Medicare.

Congress proposed similar legislation in April 2021. In an homage to the late U.S. Representative Elijah Cummings (D-MD), the U.S. House of Representatives, under the leadership of Energy and Commerce Committee Chairman Frank Pallone (D-NJ), introduced H.R. 3, the Elijah Cummings Lower Drug Costs Now Act (https://www.congress.gov/bill/117th-congress/house-bill/3/text). The bill includes a provision “to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare Part D enrollees, and for other purposes.”

House Speaker Nancy Pelosi (D-CA; 2021) designated (https://www.speaker.gov/LowerDrugCosts) H.R. 3 as one of the first numbered bills of the 117th Congress to indicate its significance in the agenda. Specifically, she pointed to giving Medicare the power to negotiate directly with drug companies and then to make the lower Medicare drug prices available to Americans with private insurance as well.

Have We Finally Reached a Solution?

As Medicare expanded from its original 1965 enactment, new provisions included hospitalization, medical, children’s health, long-term care, and support for disabilities. The Medicare Prescription Drug Improvement and Modernization Act of 2003 was the largest single extension to the program when it became law. Dubbed Medicare Part D, the section included (https://www.cms.gov/About-CMS/Agency-Information/History) an optional prescription drug benefit that went into effect in 2006. Part of H.R. 3 includes a new key provision for Medicare Part D, capping consumers’ out-of-pocket costs to $2,000 annually and allowing certain beneficiaries to pay it over the course of the entire year instead of all at once. This is particularly important for those on fixed incomes.

Building Back Better

In May 2021, moderate Democrats in the U.S. House—many members of the Problem Solvers Caucus—sent a letter (https://www.politico.com/f/?id=00000179-5df9-d7df-a37d-fffb8de30000) to Speaker Pelosi lauding health care as a top national priority. The group said that “as we look beyond the pandemic, the Biden-Harris administration has laid out an ambitious vision for improving our healthcare system, most notably in setting the goal of ending cancer as we know it. As we have just seen with the lifesaving, record-breaking development of COVID-19 vaccines and therapies, America benefits from the most innovative and capable researchers in the world, and from public-private partnership that encourages world-leading biomedical research and development.”

And in June 2021, U.S. Senate Finance Committee Chair Ron Wyden (D-OR) implored (https://www.finance.senate.gov/chairmans-news/wyden-releases-principles-for-lowering-drug-prices-for-americans) Congress to draft legislation that would “let Medicare negotiate, limit price gouging, provide relief to consumers at the pharmacy counter, ensure those with individual and employer insurance also benefit, and reward scientific research for those who are truly innovating.”

Prescription drug cost is a complicated topic involving billions of dollars and a huge sector of the economy. “We can do this,” Biden said (https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/08/12/remarks-by-president-biden-on-how-his-build-back-better-agenda-will-lower-prescription-drug-prices/) in his August 2021 announcement. “I’ve long said health care should be a right, not a privilege, in this country. And the American people support it by overwhelming bipartisan margins. This isn’t a partisan issue. Alzheimer’s, diabetes, cancer—they don’t care if you’re a Democrat or Republican. This is about whether or not you and your loved ones can afford the prescription drugs you need.”

ONS Perspective

Patient-centered care is a core principle for ONS’s advocacy work, and oncology nurses are carrying the concept forward with decision makers, citing the need for the federal government to improve access to and affordability of necessary medications.

“Prescription medications are often not as readily available as patients and providers are led to believe,” the Society said on its public health issues webpage (https://www.ons.org/make-a-difference/advocacy-policy/public-health). “Even as oncology nurses use their considerable resources to prevent or postpone gaps in medicinal regimens, these shortages still wreak havoc on patient treatment plans.”

As the most trusted and ethical profession, nurses must use their collective voice to elevate health care as a national priority.

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