Prescription Drug Price Relief Act of 2019

https://www.congress.gov/bill/116th-congress/senate-bill/102

This bill establishes a series of oversight and disclosure requirements relating to the prices of brand-name drugs. Specifically, the bill requires the Department of Health and Human Services (HHS) to review at least annually all brand-name drugs for excessive pricing; HHS must also review prices upon petition. If any such drugs are found to be excessively priced, HHS must (1) void any government-granted exclusivity; (2) issue open, nonexclusive licenses for the drugs; and (3) expedite the review of corresponding applications for generic drugs and biosimilar biological products. HHS must also create a public database with its determinations for each drug.

Under the bill, a price is considered excessive if the domestic average manufacturing price exceeds the median price for the drug in Canada, the United Kingdom, Germany, France, and Japan. If a price does not meet this criteria, or if pricing information is unavailable in at least three of the aforementioned countries, the price is still considered excessive if it is higher than reasonable in light of specified factors, including cost, revenue, and the size of the affected patient population.

The bill also requires drug manufacturers to report specified financial information for brand-name drugs, including research and advertising expenditures.

 

https://www.govtrack.us/congress/bills/subjects/prescription_drugs/6184

Congress seems hell bend on reducing the out of pocket cost for pts… keep in mind that this is the same group of 535 elected officials that can’t manage our country’s budget and has spent some 14 trillion more than we took in over the last dozen or so years.  Our national debt now stands at 23 TRILLION and continues to grow at ONE TRILLION a year.

This is the same political body that granted the insurance industry an exemption to Sherman Antitrust law in 1945 with the https://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act  Some groups tried unsuccessfully to get this latter law repealed several times in the late 80’s.   Maybe because the insurance industry has one of the largest pots of money to fund lobbyists.

It is claimed that lobbyists spend 9+ million/day trying to influence members of Congress.

What Congress doesn’t understand is that the PBM ( Prescription Benefit Manager) industry which is one of our healthcare system’s for profit middlemen. They control the payment of about 80%-90% of all prescriptions filled in this country.  They control how much profit the pharmacy makes, they demand  kickbacks/discounts/rebates from the pharma … and they get it because if the pharma doesn’t PAY UP… their meds will not be on the PBM’ s approved formulary and only get paid for by a very time consuming PRIOR AUTHORIZATION PROCESS. That kickback/discount/rebate reportedly be has high as 50% of the price of the medication.

Actually the Feds started this process back in the 70’s when they decided that since Medicaid paid so much money for prescriptions… they deserved a 10% discount on all Medicaid prescriptions. Back then the PBM industry only controlled some 10% of all prescriptions… but.. the seeds of them also getting “money back” were planted.

Unlike those other countries that Congress wants to compare our prescription medications prices with… have some sort of a national health insurance.  So there is at least THREE LESS for profit middleman expecting to cover their managerial overhead and generate a profit.

They seem to expect that we can IMPORT medications from Canada… of course Canada only has about 10% of our population and who believes that the Pharmas won’t limit the quantities of the medications that they will sell to Canada… or any other country that we expect to import meds from.

Let’s look at a hypothetical… Congress forces a pharma to reduce their price from $100 to $20 … to match the price of what it is sold in other countries…  So the PBM sends a bill to the pharma for their 50% kickback based on the previous $100 price…  who believes that the PBM is going to accept 50% of $20 when they are use to getting 50% of $100 ?  Maybe pts will see that $40 show up in their copay ?  The pharma is not going to pay the PBM the $50 that they have in the past… when they are only generating $20.

This could go wrong in so many ways…

Filed under: General Problems