Capitol Perspectives

New challenges have emerged regarding Medicare Part D which require a fundamental re-examination and modernization of the program.

A plethora of proposals are currently under consideration to wring resources out of the pharmaceutical industry, but no amount of money extracted from the life sciences sector can right-size the fundamental imbalance between the federal government’s financial obligations and taxpayers resources to finance those promises.

What is the policy problem driving the populist agenda to slash pharmaceutical spending? Answer: Rising list prices and patient out-of-pocket spending.

As Congress debates partisan issues such as “Medicare for All” where private health insurance would be outlawed, troubling trends are emerging on healthcare provider consolidation that are driving up costs.

Despite mounting evidence that pharma costs have flattened recently, the industry, during recent hearings, took licks from members on both side of the aisle in the divided Congress.

The 116th Congress convened under the shadow of a partial government shutdown with Republicans handing the gavel to newly elected Speaker Nancy Pelosi (D-CA). House Democrats have made it clear that healthcare will be a key priority, second only to investigating the Trump administration.

The latest regulatory salvo from the Trump administration on Medicare Part D and the Democratic takeover of the House of Representatives has the pharmaceutical industry scrambling to fight a multifront war to defend market-based pricing in the United States.

Two weeks before the midterm election, the Trump administration announced a sweeping plan to subject physician-administered drugs in Medicare Part B to foreign price controls. The ANPR “demonstration project” would subject half of the country to the mandatory pricing scheme but will ripple through the entire Medicare program.

“Despite predictions that our actions would increase rates and destabilize markets, the opposite has happened,” says CMS Administrator Seema Verma.

The Trump administration disrupted the typically sleepy August recess with a frenetic release of proposals that implement components of its “Blueprint” on drug pricing. Physician and patient advocates expressed concern that these proposals may result in impaired patient access to needed drug therapy.

As the midterm elections approach, with the trajectory pointing toward increasing likelihood of the Democrats taking control of the House of Representatives and with each Trump tweet on drug pricing, a feeling of foreboding has settled over the pharmaceutical industry.

A few weeks ago, Novartis became the latest Big Pharma company to depart the antibacterial field, joining Allergan and The Medicines Company, both of which — even though they manufacture the leading critical-need products — have soured on the lousy returns related to this therapeutic area.

As Congress grapples with complex ways to provide greater care coordination for seniors with multiple chronic conditions and value-based reimbursement schemes for prescription drugs, an obvious solution is being fundamentally ignored: greater enrollment in Medicare Advantage (MA).

After months of delay and suspense, in a Rose Garden ceremony, President Trump and HHS Secretary Alex Azar announced a comprehensive approach to prescription drugs, which they claimed would address major challenges.