Bust of Trump drug price
Bust of Trump drug price
One thing that Americans rightly hate about medical care is that nobody knows the real price of a service. How much did your last x-ray cost? Why do you suddenly pay more for a statin? The Trump Administration tried to address this frustration this week with a new rule that requires price disclosure in prescription drugs, but its cure is worse than the problem.
Health and Human Services has proposed a regulation that will force pharmaceutical companies to list the price of a drug in television ads, and the rule applies to any medication paid for by Medicaid and Medicare that runs more than $ 35 per month. The HHS says that this is no different from forcing companies to disclose side effects and medical warnings, nothing more than a sensible transparency that could embarrass companies to lower list prices.
This is deceptive political advertising. Almost no one pays the "list" price at the pharmacy after insurance and discounts. Nearly nine out of 10 recipes are generic, an identical version of the product that is a fraction of the cost. A generic Prilosec unit costs about eight cents versus $ 3.31 for the brand-name heartburn medication. Medicaid patients have co-payments as low as a couple of dollars, although they will not know that when they see an advertisement that says the medication costs $ 50 or $ 200 per month.
The most important problems are legal. A sleight of hand is that HHS is promulgating the rule through the Centers for Medicare and Medicaid Services, not the Food and Drug Administration, which regulates safety and the disclosure of effectiveness in drug advertisements.
HHS openly admits the rule that "Congress has not explicitly granted HHS the power to require disclosure of catalog prices to the public." But it invokes sections of the Social Security Act that mandate the agency to operate the Medicaid and Medicare programs efficiently. That seems like a setback to the Obama years: select a desired policy and then look for a broad statute to justify it.
Pharmaceutical companies will almost certainly challenge the rule as a mandatory speech that violates the First Amendment, and they have the right to do so. Courts must apply the highest standard of review ("strict scrutiny") in the measures that load the content and the speaker. This regulation distinguishes pharmaceutical companies for punishment, but not, say, hospitals. The details of the prices barely meet the legal exception for purely objective and non-controversial information, especially since the motive expressed by HHS is to embarrass the companies to lower their prices.
By the way, the pharmaceutical trade group PhRMA said this week that its member companies will voluntarily include in ad addresses a website where consumers can find what they are likely to pay. The details include: list price, disbursement costs and information about financial assistance programs.
HHS Secretary Alex Azar called this "a small step in the right direction," but he is implementing his own rule anyway. That is an advice that this is more a political exercise than a good faith effort to offer information to clients.
Another clue: HHS says we "anticipate" that the enforcement mechanism of the rule will be a private lawsuit alleging unfair competition for misleading advertising. As if spending money on trials that enrich the trial lawyers will lower the prices of the drugs.
More generally, the costs of medicines account for approximately 14% of health spending, but absorb around 99% of public attention. Much of the debate is fueled by an increasingly bitter struggle between pharmaceutical manufacturers and supply chain negotiators known as pharmaceutical benefit managers. If this continues, the losers can be the rest of us.
Pharmaceutical companies are bothered that intermediaries get large discounts and pocket part of the difference. Benefit managers complain that pharmaceutical companies are villains with huge profit margins. Congratulations, both are wrong.
In many cases, benefit managers exert downward pressure on prices when negotiating volume discounts like in any other business.
reports indicate that spending on prescription drugs per person grew by just 1.5% for business plans in 2017. As for pharmaceutical companies, they need high profit margins such as return on capital in a company where most of the innovations they fail Between 1998 and 2014, some 167 anti-lung cancer drugs failed in the trials. Only 10 arrived at the market.
The Trump Administration is getting into this debate to make it look like it's doing something, anything, about drug prices. However, the White House policy plan offered many more valuable ideas: combat the anti-competitive behavior of pharmaceutical companies; reform of a dysfunctional system of Medicaid prices, and more. Those reforms are better than their simplistic and probably illegal attack on Big Pharma advertising.
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