After years of discussing drug-price reform, federal legislators finally may be poised for action as the Biden Administration looks to advance major domestic policy initiatives, including infrastructure and health care. Last week, the Senate Health, Education, Labor and Pensions Committee held a hearing on drug-price reform the same day that House Speaker Nancy Pelosi said drug-pricing reforms could help pay a legislative package this year.
Sen. Bernie Sanders, I-Vt., also recently introduced a package of bills on the issue.
“There may actually be enough support for some drug pricing reform that something actually gets done,” said David B. Glasser, MD, the Academy’s secretary for federal affairs.
“The right drug pricing reform has to bring prices into a realistic relationship with the rest of health care costs, but it has to protect our patients — not just from a financial perspective, but from the perspective of having all of the necessary drugs available to them,” Dr. Glasser said.
The March 23 Senate committee hearing covered five key proposals:
- Allowing Medicare to directly negotiate drug prices
- Aligning prices to those in other countries (similar to the now-paused Most Favored Nation Model)
- Increasing use of biosimilars by reimbursing them at a slightly higher rate
- Requiring pharmaceutical companies to justify significant price increases
- Eliminating tax breaks for drug companies’ advertising
Late last year, the Centers for Medicare & Medicaid Services issued a now-delayed plan to address rising costs for Part B drugs. But Dr. Glasser said it’s not only high-priced drugs that create spending issues. “Sometimes, increasing … reimbursement for the less-costly drug can actually save the system money.”
With Avastin, for example, “Medicare could save hundreds of millions of dollars with just a 5% or 10% shift in market share,” Dr. Glasser said. “That isn’t happening because Avastin is currently underreimbursed by the Medicare administrative contractors, so many practices simply can’t afford to use it.”
A recent publication of Academy IRIS® Registry data in Ophthalmology® Retina documents the drop in use of Avastin for Medicare fee-for-service patients. The decline suggests that payment for this option is inadequate.
The Academy will continue to monitor the issue and keep you updated. Learn more about what the new Congress and administration could mean for health care at the Mid-Year Forum 2021 closing session, moderated by George A. Williams, MD. Academy senior secretary for federal affairs.