We’re Winning Battles, but Still Fighting the Drug Pricing War
October 1, 2019
- How can American ingenuity help solve our biggest health care problems?
- Amidst all the impeachment talk, will the government come to a halt or be more pressed to pass drug pricing legislation?
- Which states are taking health care matters into their own hands and what are Wisconsin legislators focused on?
Impeachment talk, trade tariffs, immigration reform, defense spending – there are too many pieces in the game of political chess for us to focus on them all at once. With so much going on in any given day, and news channels focusing on what they think will get the most viewership, it’s easy for some of the most important issues we face to fall to the bottom of the barrel.
Remember the battle with high drug prices and unaffordable health care?
States and the current administration have won a couple battles related to health care costs, but we’re still waging the war on drug prices that most Americans simply cannot afford.
How have states taken the lead?
Did you know that, in 2017, 4 percent of all Medicaid enrollees delayed a medical appointment simply because they lacked transportation to get there? Most Medicaid patients can’t just hail a cab on the side of the street when they have to go to the doctor. Usually, they must reserve a ride days in advance and, even then, they often share a van with other patients.
But in states like Arizona, Florida and Texas, legislators are easing rules for ridesharing drivers – Uber and Lyft for example – so they can transport Medicaid patients to their appointments. Traditionally, drivers must undergo drug testing and learn first aid and CPR before they can take a patient to the hospital or doctor’s visit. But now, Lyft is working with 35 state Medicaid programs to make medical transportation easier, and Uber began working with Medicaid in Arizona this summer.
Ridesharing apps can also replace an ambulance in non-life-threatening situations.
In addition to using ridesharing apps for Medicaid transportation, more and more Americans are opting to hail an Uber or Lyft instead of calling 911 during a medical emergency. If it’s not a life or death emergency, and you don’t want an ambulance bill that’s going to break the bank, an Uber driver may be the best option to get you to the ER.
Imagine you accidentally clip your finger while working in the garden, cut your hand on a broken glass while washing dishes, or suffer a laceration while replacing your front door. You clearly need stitches, but your car is in the shop and your wife is at work without access to her cellphone. It’s not exactly a life threatening situation, but you’re unsure if an ambulance ride is going to cost you hundreds, or even thousands, of dollars… so you decide to call an Uber.
Using ridesharing apps to make doctor’s appointments more accessible and ER visits more affordable is just the tip of the iceberg when it comes to how American ingenuity can help solve health care problems. So what else can we do to tackle out of control costs?
What are our elected leaders doing to make healthcare more affordable?
Whether you sit in the Oval Office or on Capitol Hill, as a politician, your career relies on the ability to make progress and pass legislation that benefits everyday Americans. But with impeachment talk heating up each day, many Americans are losing hope that the government will make any real progress on drug pricing legislation.
Yet there is hope that both sides of the aisle still need political wins to stay in power. According to a senior administration official, the White House will be “working energetically to move ahead” on drug pricing legislation… and according to a Democratic consultant, the impeachment process “certainly doesn’t diminish our enthusiasm to do something on prescription drug prices.”
If tackling out of control prescription drug prices is still on the table, what are our leaders going to do about it?
Everyone agrees that drug prices are too high, and that reform is necessary. But where do both sides of the aisle agree and what’s the likelihood they’ll actually pass legislation?
- Both House Democrats and Senate Republicans want to make drugmakers pay rebates if they raise their prices beyond the inflation rate
- The White House, House and Senate all want to limit what Medicare enrollees pay each year in prescription copayments
- Everyone wants the government to have some role in negotiating drug prices, considering the low prices other countries negotiate for their citizens… although there is a debate over how much pricing control the government should have
House Speaker Pelosi recently unveiled a plan that would allow Medicare to negotiate lower prices on 250 drugs, plus allow private insurers and employer-based plans to match the lower rates. The legislation will soon get a vote on the House floor, but it’s unclear whether it will pass the Senate and get the President’s signature.
While Washington works on new solutions, states aren’t waiting to lower drug prices for their citizens.
Just this year, 33 states have passed a record 51 laws to address high drug prices (after a record 45 laws were passed last year). New state laws “authorize importing prescription drugs, screen for excessive price increases by drug companies and establish oversight boards to set the prices states will pay for drugs.”
What is Wisconsin doing in the battle on drug prices?
Wisconsin is currently negotiating a bill with bipartisan support, backed by 100 sponsors, that aims to make Pharmacy Benefit Managers (PBMs) more transparent with the true cost of medication.
PBMs process claims and negotiate discounts for consumers, but they often don’t tell them that they “could save money on some drugs if they pay out of pocket instead of using insurance.” The bill has been in the works for a few months, but it’s unclear whether or not it will pass because insurance companies are lobbying against it.
The bottom line
An impeachment battle might be looming in Washington, but there is hope that politicians on both sides of the aisle still need to make progress to show that they’re actually working and not just wasting taxpayer dollars. As one Senate GOP aide recently reminded us, “when Clinton was being impeached, the Republican Congress separately passed legislation that he wanted passed,” in order to show that the government was still doing its job.
We’ll keep you updated on whether new drug pricing legislation is likely to make its way to the President’s desk, and how that might impact your Paycheck. Sign up for our newsletter for weekly updates!