Drug-pricing policies find new momentum as ‘a 2020 thing’

The next presidential primary contests are more than a year away. But presumed candidates are already trying to stake a claim to one of health care’s hot-button concerns: surging prescription drug prices.

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“This is a 2020 thing,” said Peter B. Bach, MD, who directs the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York and tracks drug-pricing policy.

Spurred on by midterm election results that showed health care to be a deciding issue, lawmakers – some of whom have already launched presidential-run exploratory committees – are pushing a bevy of new proposals and approaches.

Few if any of those ideas will likely make it to the president’s desk. Nevertheless, Senate Democrats eyeing higher office and seeking street cred in the debate are devising more innovative and aggressive strategies to take on Big Pharma.

“Democrats feel as if they’re really able to experiment,” said Rachel Sachs, an associate law professor at Washington University, St. Louis, who tracks drug-pricing laws.

Some Republicans are also proposing drug-pricing reform, although experts say their approaches are generally less dramatic.

Here are some of the ideas either introduced in legislation or that senators’ offices confirmed they are considering:

• Make a public option for generic drugs. The government could manufacture generics (directly or through a private contractor) if there is a shortage or aren’t enough competitors to keep prices down. This comes from a bill put forth by Sen. Elizabeth Warren (D-Mass.) and Rep. Jan Schakowsky (D-Ill.).
• Let Medicare negotiate drug prices. This idea has many backers – what differs is the method of enforcement. Sen. Sherrod Brown (D-Ohio) has suggested that if the company and the government can’t reach an agreement, the government could take away the company’s patent rights. A proposal from Sen. Bernie Sanders (I-Vt.) and Rep. Elijah Cummings (D-Md.) would address stalled negotiations by letting Medicare pay the lowest amount among: Medicaid’s best price, the highest price a single federal purchaser pays or the median price paid for a specific drug in Canada, France, Germany, Japan, and the United Kingdom.
• Pay what they do abroad. Legislation from Mr. Sanders and Rep. Ro Khanna (D-Calif.) would require companies to price their drugs no higher than the median of what’s charged in Canada, France, Germany, Japan, and the United Kingdom. If manufacturers fail to comply, other companies could get the rights to make those drugs, too.
• Penalize price gouging. This would target manufacturers who raise drug prices more than 30% in 5 years. Punishments could include requiring the company to reimburse those who paid the elevated price, forcing the drug maker to lower its price, or charging a penalty up to three times what a company received from boosting the price. Backers include senators Richard Blumenthal (D-Conn.), Kamala Harris (D-Calif.), Jeff Merkley (D-Ore.), and Amy Klobuchar (D-Minn.).
• Import drugs. A Sanders-Cummings bill would let patients, wholesalers, and pharmacies import drugs from abroad – starting with Canada, and leaving the door open for some other countries. Sen. Chuck Grassley (R-Iowa) and Ms. Klobuchar have a separate bill that is specific to patients getting medicine from Canada alone.
• Abolish “pay for delay.” From Mr. Grassley and Ms. Klobuchar, this legislation would tackle deals in which a branded drugmaker pays off a generic one to keep a competing product from coming to market.