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Steps To Fix America's Broken Prescription Drug System

This illustration image shows tablets of opioid painkiller Oxycodon delivered on medical prescription taken on Sept. 18, 2019 in Washington, D.C. (Eric Baradat/AFP via Getty Images)
This illustration image shows tablets of opioid painkiller Oxycodon delivered on medical prescription taken on Sept. 18, 2019 in Washington, D.C. (Eric Baradat/AFP via Getty Images)

Americans jump through too many hoops, travel too far, and pay too much for their prescription drugs.

Take Ann Lovell. She had to take an expensive medication.

So her insurance provider made her an offer: she’d get her prescriptions on an all-expenses paid trip from Utah to Mexico.

Can America’s broken prescription drug system be fixed?


Jonathan Cohn, senior national correspondent for HuffPost. Author of “The Ten Year War.” (@CitizenCohn)

Jack Beatty, On Point news analyst. (@JackBeattyNPR)

Rep. Scott Peters, U.S. Representative from California’s 52nd congressional district. (@RepScottPeters)

Rep. Jan Schakowsky, U.S. Representative from Illinois’s 9th congressional district. (@janschakowsky)

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Ann Lovell, a former teacher who traveled from Utah to Mexico five times for her medication.

Utah State Rep. Norman Thurston, who sponsored the Right to Shop bill in 2018.

Interview Highlights

What’s going on in the House regarding this renewed effort to get a hold of prescription drug pricing?

Jonathan Cohn: “Two years ago, House Democrats got together and as you say, we’ve been talking about this for a long time, Democrats have been talking about this for a long time. Even some Republicans have been talking about this for a long time. Prescription drug prices are too high. We need to do something. And the big idea out there is to have the government negotiate prices with manufacturers. Which, by the way, is what happens in every other developed nation. And it’s why they spend so much less on their prescription drugs.

“Two years ago, House Democrats actually got together and they had a very contentious debate among themselves and they were able to put together a bill and they actually passed it. Speaker Pelosi saw through the process, and they put together this bill that would have introduced government negotiation of prices and would have taken a bunch of other steps, would have brought down prices for consumers, and saved the government a bunch of money. Now, at the time the Republicans controlled the Senate, Mitch McConnell refused to take it up and Donald Trump was president, and didn’t really push to have it taken up.

“Well, fast forward two years now. Democrats have control of the Senate. They have a Democrat in the White House. And so there’s another effort to make this happen, and they are close. But the Democratic majority in the House is much smaller than it was. In the Senate is exactly 50 votes, which is the minimum you need to pass a bill. And so they need almost complete unanimity in the House. They need to get the entire Senate. And there are a few holdouts who say, No, we don’t like this bill in the House. And so right now, the House is trying to negotiate what [it is] going to take to get those holdouts on board.”

If we, the American people, allowed Medicare to vigorously negotiate prescription drug prices, would that put American science at risk?

Rep. Jan Schakowsky: “Absolutely not. …  It’s not just lowering the drug prices for seniors, for all Americans. This kind of negotiation would stop Americans from paying two to three times more for the same drugs as people around the world. You know, we’re somehow the chumps here having to pay so much more.

“And what we know is that the leading drug companies have spent $56 billion more on stock buybacks, and dividends for investors, for CEO pay than they actually invested in research and development last year. And so we are risking innovation. We are risking new drugs. And by the way, American taxpayers spend a lot — billions and billions of dollars. In fact, the top 356 newest drugs that were produced were all paid in part, in the research and development, by tax payers.”

On why Rep. Peters voted ‘No’ on prescription drug pricing legislation before it could come to the House floor for a vote 

Rep. Scott Peters: “I voted no on that plan. There’s no disagreement among Democrats that we have to lower the cost of prescription drugs for seniors. And I fully support that. The problem with the current proposal, which we call H.R.3, is that it’s really not a negotiation about prices. It sets a price based on an international reference. And then assesses a 95% tax against a company that would not pay that price.

What that does is while it does lower drug costs, it also really threatens the future of investment in these innovations. So you think about the development of drugs and discovery. It’s a partnership of the public sector in the private sector. Democrats have worked really hard to increase the budget for the National Institute of Health from $29 billion when I first came to Congress in 2013, to $43 billion now. But in the private sector, the private sector invests about $100 billion in turning that science into products.

“And it’s a high risk business. It costs a billion dollars to bring a drug to to market, and at no risk to taxpayers. But mostly they fail. And we only pay for them when they’re deemed to be safe and effective at the back end. What we don’t want to do is this incentivized that investment by changing the return without changing the risk profile. And that’s what I’m afraid that H.R.3 would do.”

On lessons for the pharmaceutical industry from the fight over Obamacare 

Jonathan Cohn: “I don’t think it’s an exaggeration to call the pharmaceutical lobby the most powerful lobby in Washington, D.C. And the story of Obamacare, the Affordable Care Act, one of the ways they got that bill through was they basically went easy on Pharma and they basically bought peace with that because they knew they couldn’t beat Pharma. Now, it’s been 10 years. Politics are different. I think the outrage over drug prices has grown.

“I think the political incentives for Democrats are a little different this time, in that I really feel like they feel like they need to deliver. And the drug pricing reforms, if you poll like all of the list of things that Democrats are trying to do right now, it is literally the top most popular item. It’s popular with Democratic voters, it’s popular with independent voters, it’s popular with Republican voters. So there is a very strong incentive to make this happen.

“And if I wanted to give you the sort of optimistic take, if you want this to pass and you’re thinking about Representative Peters, I do think it’s notable that he is out there saying, I want to do drug price negotiation and I want to do these other things. He’s not taking negotiation off the table. So you got to think there’s some middle ground between what he’s talking about, and what Nancy Pelosi and what other House Democrats want. That they could find some agreement, maybe.”

So what are the steps out of this? 

Jonathan Cohn: “It is bizarre. And it’s ironic. Of all people, Donald Trump used to get angry about this. And he was the one who said, We pay too much. And so in some ways, fixing this problem is in part about getting the U.S. to pay what other countries do. So we’re not, you know, getting the raw end of the stick. And I do think there’s still a decent chance this could happen.”

This article was originally published on WBUR.org.

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