Weekly Column: Working To Lower Prescription Drug Costs For Idahoans

America’s biopharmaceutical innovation recently brought life-saving vaccines to combat the COVID-19 pandemic in under one year.  This same medical ingenuity is leading the world in bringing life-saving therapies to patients and discovering cures for the future.  However, access to affordable prescriptions remains one of the most persistent challenges facing our nation, and these treatments are only effective if patients can afford them.  I recently reintroduced the Lower Costs, More Cures Act to lower prescription drug prices, bring greater transparency to the prescription drug industry and encourage American ingenuity in the development of new treatments and cures.

A study suggested that 37 percent of Idaho residents stopped taking medication as prescribed in 2017 due to cost.  Additionally, the non-partisan Congressional Research Service (CRS) reports, “Americans are using more prescription drugs, and for longer periods of time, than in past decades.  Still, access to prescription drugs remains an issue for a number of consumers, particularly those without insurance; those enrolled in private insurance or public health plans that impose high cost-sharing requirements, such as drug deductibles and coinsurance; and those prescribed expensive specialty drugs for treating serious or rare diseases.”  Further, citing National Health Expenditures data, CRS found, “the United States spent $369.7 billion on prescription drugs in 2019 and a projected $358.7 billion in 2020.”

S. 2164, the Lower Costs, More Cures Act (LCMCA), is a comprehensive, market-based approach to leveraging competition, flexibility and transparency to bring affordable drugs to patients without stifling innovative growth and research.  The legislation includes provisions to accomplish the following:

• Modernize payments for drugs delivered in the doctor’s office under Medicare Part B;

• Incentivize lower-cost alternatives, or biosimilars;

• Establish an annual out-of-pocket cap of $3,100 for Medicare Part D enrollees and allow certain patients to pay in monthly installments;

• Decrease beneficiary cost sharing from 25 percent to 15 percent of costs before the out-of-pocket cap is reached;

• Allow prescription drug plan sponsors to offer, at minimum, up to four Part D plans per region, spurring competition and innovation;

• Make permanent the Center for Medicare and Medicaid Innovation model that enables Part D enrollees taking insulin to limit out-of-pocket costs to $35;

• Allow state Medicaid programs to enter into outcomes-based agreements to pay for life-saving gene therapy treatments;

• Provide the U.S. Department of Health and Human Services Secretary with the authority to require drug manufacturers to provide pricing information on all direct-to-consumer advertising;

• Codify a Trump Administration regulatory action that classifies insulin and other treatments for chronic conditions as preventative care so that high deductible health plans can cover costs before the patient reaches the deductible; and

• Create a trade negotiator solely dedicated to putting American patients first in government trade negotiations related to medicines in order to prevent foreign free-loading off America’s investment.

Full text of the LCMCA and a section-by section is accessible on the Senate Finance Committee website: https://www.finance.senate.gov/.

Senator Richard Burr (R-North Carolina), Ranking Member of the Senate Health, Education, Labor and Pensions Committee joined me in reintroducing this legislation.  Other original co-sponsors include Senators Steve Daines (R-Montana), Tim Scott (R-South Carolina), Jim Risch (R-Idaho), Thom Tillis (R-North Carolina), Joni Ernst (R-Iowa) and Roger Marshall (R-Kansas).  Reintroduction of this legislation is part of my ongoing work to improve access to affordable medications for patients, while adhering to market-driven principles.   

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