Proposed federal law can help manage rising drug prices


Prescription drug prices are rising faster than summer temperatures in the Sonoran Desert. For more than a decade now, Arizonans have seen common prescription drugs double or triple in price. What’s more, this has left many vulnerable communities, especially seniors on Medicare, struggling to pay for their life-subsisting prescription drugs.

Instead of taking their medication as prescribed, many Arizonans are rationing doses or not filling their prescriptions because the cost is too high. Both options place many of our neighbors in risky and dangerous positions. However, there is a way—currently standing before Congress—to end these life-threatening scenarios.

David Bailie
David Bailie

Senator Chuck Grassley’s Prescription Drug Pricing Reduction Act (PDPRA) would help Medicare beneficiaries pay for their prescription drugs and would mitigate price hikes. Potentially, this bill would help the 36 percent of Arizonans who ration or do not fill their prescriptions and the 26 percent of residents who stopped taking their prescription drugs altogether because they could no longer afford these medications.

The PDPRA reforms Medicare and protects beneficiaries from rising prescription drug prices. Among the protections in the bill is an annual $3,100 cap on out-of-pocket expenses for Medicare Part D beneficiaries, meaning they would no longer be responsible for virtually unlimited out-of-pocket costs to cover high drug bills.

Instead, the responsibility of covering those costs would be passed primarily to insurance and pharmaceutical companies. This transfer of duty would encourage insurance companies to negotiate lower drug prices, as their bottom lines could be affected in the long run.

Shifting responsibilities is one of two ways the PDPRA addresses rising prescription costs. The second method is Congress financially penalizing companies that raise their drug prices faster than the rate of inflation. This in turn would discourage price gouging – and, as a byproduct of this measure, Americans who are not on Medicare would also see steady prices in the consumer market.

In addition to penalties and out-of-pocket caps, the PDPRA would allow the public to see how the pharmaceutical industry prices its products. This transparency into drug prices would serve as another check on the industry and would deter companies from excessively increasing prices (as now consumers can see whether those price hikes are justified).

These measures, as outlined in the PDPRA, have received wide support from Arizona voters. For example, a recent survey found that 82 percent of voters support requiring pharmaceutical companies to reveal their pricing schemes.

Despite voter approval, the PDPRA still needs votes in the Senate to pass Congress.

Fortunately, U.S. Sen. Martha McSally understands how rising prescription drug costs have harmed our state. She has spoken with constituents on how the issue has affected them and has met with pharmacies to investigate the cause and impact of price hikes.

This has all demonstrated her commitment to the issue – and, as a constituent, I am grateful for this. I am also hopeful that Senator McSally will support the PDPRA to help resolve this crisis. The PDPRA is the most comprehensive bill in Congress that provides transparency, protects seniors on Medicare, and helps manage prescription drug price increases. With Senator McSally’s support, we can take a major step forward in making prescription drugs more affordable.

Dr. David Bailie, a Scottsdale-based orthopedic surgeon, is an expert in the area of sports medicine and has been a practicing medical doctor since 1990.  

Sunlight best disinfectant for rising drug costs

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The 118th Congress will protect Medicare and prescription drug reforms that Arizonans rely on.

A recent op-ed published in these pages from former Arizona Congressman J.D. Hayworth rightly argues that prescription drug costs are out of control. Expenditures on pharmaceuticals in the U.S. have exploded — more than tripling since the year 2000. And sadly, as a result of rising prices, 35% of Americans are reportedly not taking prescribed medication as directed.

It’s a health care crisis that’s mounting by the day.

But rather than taking a holistic approach to addressing bloated medicine prices, the former congressman has blinders on. He argues the problem is a result of pharmaceutical manufacturers alone without acknowledging the drawbacks created by other players. Considering the U.S. health care system is a complex web of insurance companies, hospital systems, pharmacies, and supply chain middlemen, the stance is naïve at best.

Kristen Bishop

While demonizing drug makers, the former congressman gives a full-throated defense of Pharmacy Benefit Managers (PBMs) — better known as the middlemen of the drug supply chain. But PBMs are not the altruistic entities that Hayworth makes them out to be.

PBMs are huge corporations that rake in more than $300 billion a year, with three of the largest ones controlling 80% of the prescription market. And considering that PBM profits have more than doubled over the past decade while offering limited additional value, it’s reasonable to wonder where the money is coming from? Hint: Not from thin air. The billions are being syphoned from the drug supply chain at the expense of patients.

PBMs act as the gatekeepers to the consumer market — a position that gives them considerable leverage to demand drugmakers provide discounts alongside their products. It’s akin to paying a cover charge at a bar or nightclub just to get through the door. However, unlike what the PBM lobby suggests, those discounts don’t get passed down to consumers. The cash is pocketed by PBMs.

As the middlemen continue to game the system, a strong natural experiment has unfolded to help shed light on the cost-multiplier PBMs inject into the drug market. Enter “Shark Tank” investor and Dallas Mavericks owner Mark Cuban.

The entrepreneur has launched an online pharmacy that buys medicine directly from manufacturers — subsequently selling the product to consumers at a heavily discounted price while still making a modest profit. For example, the cancer drug Imatinib sells for $12 on the website when the retail price is 200-times that. Meanwhile, an ulcerative colitis medication sells for nearly one-thirtieth of the retail cost.

What’s the secret to the cost saving magic? Cuban’s company is able to bypass the PBM bloat that’s largely responsible for the high drug prices Americans typically experience at the pharmacy counter. It just goes to show there’s a better way.

The U.S. health care system is plagued with complexity. Without transparency, that can lead to bloated costs that compromise the health of Americans. High drug costs are a prime example. Bipartisan efforts in Congress to inject transparency into the drug supply chain should be encouraged.

Sunlight is the best disinfectant.

Dr. Kristen Bishop is the owner of Keystone Natural Family Medicine in Arizona and is a partner of the Job Creators Network Foundation.