Arizona senators have chance to hold Big Pharma accountable


I have been practicing medicine for over 20 years, I know firsthand the emotional and financial struggles families face when grappling with health care decisions.

When I was Chief Medical Officer of the Navy, I helped direct one of the country’s largest health care systems. It was my duty to deliver top-quality care to nearly 9.5 million patients in a system with over 63,000 dedicated health care professionals and a budget of $50 billion. Whether serving our troops in Afghanistan and Iraq, or working to stop the outbreak of the Ebola virus in 2014, we were able to adapt, innovate and act to deliver quality care for our servicemen and women and their families.

We faced and tackled unique challenges in the most difficult environments and still were always able to complete the mission. If we could complete our mission under those circumstances, then Congress has absolutely no excuse to deliver on its commitment to hold Big Pharma accountable and lower prescription drug prices, amid this crisis of affordability.

Steve Ferrara
Steve Ferrara

The drug pricing crisis has spiraled out control thanks to the anti-competitive tactics and price-gouging behavior of powerful pharmaceutical companies. Millions of patients are risking their health and facing financial ruin because drug companies game the system to build monopolies around their products, and then repeatedly hike prices.

Between January and June of this year, drug companies hiked prices by an average of 10.5 percent on nearly 3,500 drugs – far outpacing the rate of inflation. In 2018, there were 96 prices increases for every price reduction.

This is just the latest evidence of a crisis that has been in the making for decades. Over the course of the last five years, the price of medications manufactured by the brand name prescription drug makers have increased at 10 times the rate of inflation.

The skyrocketing price of prescription drugs has left as many as one in four Americans struggling to afford their medications — with far too many resorting to rationing or other dangerous measures in an attempt to make ends meet.

Our lawmakers in Congress simply must act – and swiftly.

Fortunately, there is legislation being considered before the U.S. Senate right now that would hold Big Pharma accountable and take several positive first steps to lower prescription drug prices.

The bill, The Prescription Drug Pricing Reduction Act of 2019, has already advanced through a key Senate panel with broad bipartisan support.

The nonpartisan Congressional Budget Office (CBO) has confirmed the bill would save taxpayers more than $100 billion, reduce out-of-pocket costs for seniors by nearly $30 billion, reduce premiums for both Medicare Part D beneficiaries and also achieve lower costs for patients with private insurance.

This important legislation would also hold Big Pharma accountable by protecting taxpayers from price-gouging, disincentivizing excessive price hikes on drugs covered by Medicare Part D, boosting list price transparency and supporting greater use of biosimilars.

Additionally, it provides immediate relief for many of our most vulnerable Arizona citizens – our seniors. The Senate Finance package brings much-needed reforms to Medicare Part D by capping out-of-pocket costs and shifts significant liability for drug makers in the catastrophic phase – guaranteeing seniors see savings at the pharmacy counter and bringing market forces to bear to discourage rampant price hikes from drug makers.

Congress simply must act swiftly to advance these measures when they return from their August recess, before the political firestorm of the 2020 election threatens to derail any hope of bipartisan action to deliver results for struggling Arizona patients, seniors and families.

I respectfully encourage U.S. Sens. Martha McSally and Kyrsten Sinema to join their colleagues, on both sides of the aisle, in endorsing this legislation and working to ensure it passes on the Senate floor in the coming months.

There is unprecedented momentum to hold Big Pharma accountable and lower prescription drug prices for patients. Our lawmakers need to capitalize on this moment and complete their mission.

Dr. Steve Ferrara served in the U.S. Navy from 1991 to 2016 and retired with the rank of captain. While in the U.S. Navy, he served as the chief medical officer from 2013 to 2015. He also served as a Congressional health policy fellow from 2012 to 2013.

Congress: Lower the cost of prescription drugs

Drug prices have increased tremendously over the last several decades. These price increases have affected a wide range of drugs, impacting nearly all Americans who rely on prescription medications to maintain their health. This increase in the prices of drugs in the U.S. represents one of the major threats to the health of the population, economic growth, and trade flows. This is not new information, of course. But what is novel is that the U.S. government is finally poised to do something about it – so long as Congress agrees to it. 

 On November 19, the U.S. House passed President Biden’s Build Back Better Act, which includes a crucial provision that would allow the federal government to negotiate drug prices through its Medicare program. This provision must remain in the Senate’s version of the bill if we are to finally reign in the astronomical cost of prescription drugs in this country. 

Heart disease, cancer, and diabetes, are major causes of death in the U.S., yet drugs for these conditions have become increasingly expensive. Because of this surge in drug prices, patients take fewer tablets to save money, worsening health outcomes. And for the millions of Americans without health insurance, higher prices hit especially hard, disproportionately harming the poorest patients. 

Bashar Malkawi

In this context, the Build Back Better Act plays an important role in the debate over drug prices. It’s prime time for the U.S., a leader and shining torch for other countries, to move forward with a health system that works for all, including with affordable drug prices. 

In terms of the actual provisions incorporated in the bill, it is fair to say that the bill is a win-win for all parties involved. It allows the federal government to negotiate prices for some high-cost drugs covered under Medicare Part B and Part D. This would result in lower prices of high-cost drugs without generic competition. 

The new plan would be phased in, targeting the highest price medications that lack competition. More specifically, negotiations over prices would only involve 10 drugs in 2025, 15 drugs in 2026 and 2027, and 20 drugs in 2028 for single-source brand-name drugs that lack generic competition. These drugs would be selected from among the 50 drugs with the highest total Medicare spending.   

In addition, Build Back Better exempts from negotiations for nine years any small-molecule drugs and for 13 years any biological products, starting on their FDA-approval date. Arizona Senator Kyrsten Sinema helped secure this language, which should allay concerns by pharmaceutical companies that the popular prescription drug negotiation measures will hurt incentives for research and development. In sum, Build Back Better is a well-balanced bill that incorporates rules that protect the interests of both the public and drug companies at the same time.   

 It is critical that the final bill retains at least the basic provisions of prescription drug reform included in the House-passed version: Medicare negotiation, inflation rebates, and caps on out-of-pocket drug spending and cost sharing for insulin and adult vaccines. It is high time for the U.S. Senate to get its act together and approve these meaningful and commonsense ways to lower the cost of prescription drugs and put the interests of patients first. 

Bashar Malkawi is global professor of practice in law at the University of Arizona.   


Prescription Drug Solutions Overdue, Sinema and Kelly Must Act

During my time as an elected official in Arizona, I have heard anecdotes about impossible decisions families are forced to make due to out-of-control prescription drug costs. Horrible choices like deciding to buy critical medications or paying the rent, buying groceries, or paying the utility bill. This is a choice no one living in a country as prosperous as American should ever have to make.   

Here in the Arizona Senate, Democrats have worked to come up with solutions to give relief to patients. But our families, seniors and small businesses — struggling under the cost of medications — also need significant solutions that can only be delivered at the federal level. This is why we need our representatives in Congress, particularly Sens. Krysten Sinema and Mark Kelly, to stand up to the powerful influence of pharmaceutical companies and pass reforms that will tackle the crisis of prescription drug affordability and give Arizonans much need help.  

Lela Alston

In January 2021, drug makers hiked prices on 822 brand name prescription drugs. Six months later, in July 2021, an additional 67 brand name prescription drugs increased their price. A recent report from AARP Public Policy Institute showed that between 2015 and 2019, on average 90 percent of the top 50 most popular drugs among Medicare Part D beneficiaries increased their price at rates higher than the rate of inflation. These targeted price hikes affect my district immensely as 10.6 percent of my constituents are age 65 or over. And the repercussions are felt across the state as we have over 1.3 million Medicare beneficiaries across Arizona.   

The pharmaceutical industry argues that their pricing practices are necessary to support the development of new medicines and claim solutions to lower drug prices would put innovation at risk. But earlier this year, a report from the nonpartisan Congressional Budget Office (CBO) found investments made in research and development for a drug ultimately have no impact on how drug companies determine its price.  

In particular, Congress should place a cap on out-of-pocket spending for seniors, stop drug makers from increasing drug prices at rates higher than inflation and deter price-gouging by giving drug makers significant cost sharing responsibilities for seniors who reach the most expensive tier of coverage under the Part D program. These solutions have already won enough support in the U.S. House to advance — the impetus is now on the Senate to act.   

I am urging Senators Sinema and Kelly to join the growing majority of Americans who support immediate action to hold brand name drug companies accountable and lower prices on life-saving medications. Sinema and Kelly have promised results on this issue. Congress must address the cost of prescription drugs.   

Over my tenure in the Arizona Legislature, I have seen few problems so devastating to our communities as out-of-control drug prices. It is time for our elected officials in Congress to ensure this problem is addressed this year, so families no longer have to make impossible decisions just to line pharmaceutical executives’ pockets. It’s time to reject the branded drug industry’s misleading rhetoric. Arizonans need results on drug pricing solutions now.    

Lela Alston is an Arizona State Senator who represents District 24.  



Support legislation to incentivize non-opioids pain therapies

Dear Editor:

Opioids cost 1,375 Arizonans their lives in 2018 alone. This is a public health epidemic, and we need to leverage every available public-health policy tool to reduce opioid addiction. Fortunately, research into safer pain relievers is paying off and FDA-approved, opioid-free alternatives are now available. This means patients can recover from medical procedures in comfort while taking fewer, if any, opioid doses.

Sadly, these non-opioid medications aren’t being prescribed as often as they should for Medicare patients. The good news is that Congress is considering legislation to modernize Medicare reimbursements that will incentivize the use of non-opioid pain therapies. This would shift post-surgical treatment protocols in a safer direction and give doctors alternatives for responsibly treating pain without prescribing potentially addictive opioids.

On behalf of the Arizona Public Health Association, we urge Arizona’s elected leaders to support the NOPAIN Act (H. 5172) to ensure Medicare beneficiaries get the safest medical treatment possible.

Will Humble

Director Arizona Public Health Association and former director of the Arizona Department of Health Services.

What policymakers need to know about plan to rein in Medicare drug costs


Across Arizona and across the country, much attention is being paid to prescription drug costs – and with good reason. Patients are paying more out-of-pocket for health care while premiums continue to rise, often forcing them to make the difficult choice between paying for their medicines or putting those funds toward other necessities. According to a recent Kaiser Health Tracking Poll, almost one-quarter of the nation’s seniors report that they have difficulty affording their prescription drugs. As a result, many will split their pills, skip doses, or forgo the prescribed drug altogether.

Victor Riches
Victor Riches

There is clearly enthusiasm to “do something” about prescription drug costs, but one of the current proposals on the federal level may cause further financial harm to many of the state’s seniors, possibly making it even more difficult for them to pay for their prescriptions. Arizona policymakers should know about and understand how these reforms will affect our state’s seniors, as well as the state’s taxpayers, who pay for retiree health benefits for the Arizona State Retirement System.

Today, about one in six Arizonans are retirees age 65 and older, most of whom rely on the federal Medicare program, the federal health insurance program for the nation’s elderly. The U.S. Department of Health and Human Services recently introduced a proposal, the so-called “Rebate Rule,” that would prevent pharmacy benefit managers (PBMs) from negotiating rebates with drug companies for the prescription drugs upon which Medicare recipients rely.

Another opinion recently published in the Arizona Capitol Times claimed that PBMs are a barrier that keeps beneficiaries from accessing affordable prescription drugs. But while this opinion referred to PBMs as the “middlemen” of the drug industry, in truth, they provide an important function in negotiating lower drug prices for Medicare recipients. It is true that PBMs receive rebates for brokering these deals, but it is also important to recognize that, because of negotiating with manufacturers for lower prices, Medicare recipients pay less for their drugs as a result.

Here’s how it works: PBMs negotiate with drug-makers on behalf of Medicare to get discounts for the 900,000 Arizonans who participate in the Medicare program’s Part D prescription drug program. Then the bulk of the savings negotiated are passed on to patients by reducing their out-of-pocket costs. PBMs save patients an average of over $2,000 annually for these patients.

Without PBMs working as negotiators in this process, pharmaceutical prices would be left almost solely to the discretion of drug manufacturers. So, PBMs provide a check on the pricing system – and patients benefit.

The government’s own studies reveal just how much of a burden this change will create. The Centers for Medicare and Medicaid Services, which operates the Medicare program, estimates that seniors’ Medicare Part D premiums will increase by 19 percent in 2020 alone and 25 percent overall if the Rebate Rule is enacted. That price hike isn’t affordable for most seniors – least of all for those already struggling to pay for their prescription drugs.

The state of Arizona’s retirement system could be hit particularly hard. That is because the current proposal doesn’t shield group Medicare plans, including state employee retirement programs around the country, from higher premiums for enrollees because, due to somewhat arcane rules, these plans cannot shift money (using risk corridor payments that will be available to other Medicare plans) to cushion the inevitable increase in premiums that recipients will face.

Unfortunately, the proposed Rebate Rule does nothing to require or even encourage drug companies to lower their prices. We need our elected representatives and the administration to refocus the discussion on prescription drug pricing reform toward market-based solutions that increase price transparency and boost competition. That is the only way to ensure both access to lower prescription costs for Arizona’s seniors and fidelity to taxpayers.
Victor Riches is president and CEO of the Goldwater Institute.