Public Citizen News / November-December 2019
By Rhoda Feng
This article appeared in the November/December 2019 edition of Public Citizen News. Download the full edition here.
In September, a bill to lower drug prices made headlines when Bloomberg Government published a leaked summary of H.R. 3, the U.S. House Democratic leadership’s long-awaited signature legislation to lower prescription drug prices.
Public Citizen wasted no time in hosting a telephone press conference call to discuss the Lower Drug Costs Now Act’s benefits and limitations. Joining Public Citizen experts on the call were Congressional Progressive Caucus co-chair U.S. Rep. Mark Pocan (D-Wis.) and partners from Social Security Works and Indivisible.
The verdict? H.R. 3 is an important move toward bringing relief to people suffering from drug industry price-gouging. In addition, Public Citizen supports strengthening it to make medicine affordable for all.
Inspiring Better Legislation
If H.R. 3 is an on-ramp to a larger conversation about drug pricing, the conversation itself has been enlarged through the work of Public Citizen. Tens of millions of people ration their own treatment in the United States because of sky-high prescription drug prices, and many endure crushing debt. Just a few years ago, the bulk of Washington’s power elite, including most lawmakers, was content to accept that prescription drug corporations rip off the American people this way.
Advocates with Public Citizen and millions of Americans have raised their voices, organized and demanded that their government do better. They have fought despite illness. They have stood up for their loved ones. They are on the cusp of change, and Public Citizen has led the way.
For several years Public Citizen has held monthly organizing meetings with other nonprofits, conducted briefings for congressional staffers and issued policy analyses.
In 2018 – more than a year before H.R. 3’s introduction – Public Citizen began working with U.S. Rep. Lloyd Doggett (D-Texas) to draft the Medicare Negotiation and Competitive Licensing Act, which was introduced in February and has the support of more than 120 House Democrats. It gives the U.S. Department of Health & Human Services (HHS) direct power to negotiate drug prices with manufacturers. The bill also gives the agency the power to license patents and introduce generics when drugmakers do not offer a reasonable price.
Meanwhile, Democratic Party leaders were crafting a much more modest plan to lower prices through arbitration, which would have empowered a third party to decide what the government must pay for a prescription drug.The Doggett bill, though, set the standard for drug pricing legislation and the parameters for legislative debate. Public Citizen then worked to make clear that these components should be part of any overall package.
By the time Public Citizen held its telephone press conference, arbitration had been removed from the legislation. The bill still empowers the U.S. government to negotiate directly with drugmakers for lower prices, but it imposes a steep tax penalty on companies that refuse, rather than sending the matter to arbitration. That would mean a better deal not only for Medicare patients but for people with private insurance. H.R. 3 also would guard against price spikes by requiring drug companies to pay rebates to Medicare when they increase prices beyond the level of inflation.
“Democratic leaders understand that after their Better Deal pledge to midterm voters, they need a big drug pricing bill around which Democrats can rally,” said Peter Maybarduk, director of Public Citizen’s Access to Medicines program.
Making It Even Better
Yet the legislation has limitations that must be addressed. The plan, for instance, does not restrain how much consumers pay for new drugs. And it doesn’t allow the government to negotiate prices for all drugs. So patients who use expensive medicines that do not qualify for negotiation may still be at the mercy of Big Pharma’s price gouging.
Some aspects of the plan rely too heavily on prices abroad, which derive from monopolies just as they do in the U.S., rather than providing a fresh opportunity to establish fair prices related to real research investments and priorities.
“Fundamentally, high medicine prices are rooted in the monopoly powers our government grants to prescription drug corporations,” Maybarduk said. “Making medicine affordable for everyone requires that we challenge this power.”
Strengthening H.R. 3
Some of the issues with H.R. 3 may be remedied ahead of a final vote on the floor of the U.S. House. For example, on Oct. 16, the U.S. House Education and Labor Committee incorporated an amendment sponsored by U.S. Rep. Pramila Jayapal (D-Wash.) to expand price spike protections beyond Medicare to employer-sponsored health plans. As Public Citizen News went to press, Public Citizen and progressive allies inside and outside of Congress were working to further strengthen the bill through amendments, including through ensuring people without insurance can benefit from lower prices and expanding negotiations to cover more drugs.
“The changes made so far to the legislation from its more conservative, earlier iteration testify to the power of patients and their families who spoke out about medical debt and treatment rationing and demanded that their government do better,” said Steve Knievel, advocate with Public Citizen’s Access to Medicines group. “Ultimately, making medicine affordable will require going further to disrupt corporate monopoly pricing.”