Op-ed: To cut drug prices, start with the facts

This editorial by Peter J. Pitts was published in Deseret News on March 9, 2018. Mr. Pitts is a former FDA associate commissioner, is president of the Center for Medicine in the Public Interest.

Op-ed: To cut drug prices, start with the facts

Americans are paying too much for prescription medicines. State lawmakers are fed up with Washington's apparent apathy towards high pharmacy bills. So they're taking matters into their own hands and pushing forward with several bills to fix the problem.

Their proposals are well-intentioned — but they're doomed to backfire and hurt patients. Why? Well, the bills are based on false assumptions.

Many lawmakers believe that prescription drug prices are skyrocketing. They're not. In fact, after accounting for all the rebates and discounts manufacturers offer, drug prices have barely budged in recent years. Drug spending grew just 1.3 percent in 2016, according to the latest federal data from the Centers for Medicare & Medicaid Services. Overall health spending increased by 4.3 percent.

In other words, drug spending is growing slower than hospital and nursing home expenditures. In fact, it's growing even slower than the general inflation rate, which has averaged just under 2 percent.

Legislators also blame drug prices for rapidly rising costs in Medicaid, the entitlement program for low-income Americans that is managed and partly funded by the states. Once again, they're mistaken.

Drug companies provide generous discounts and rebates back to Medicaid to curb its overall prescription drug spending. Medicaid's statistics rarely reflect these discounts. In 2014, the program reported that its gross spending on drugs reached an eye-popping $21 billion. But after factoring in discounts, the program actually spent only $8 billion on medicines.

Federal law guarantees Medicaid the lowest drug prices on the market.

Nevertheless, state lawmakers insist that drug companies are charging too much. So they're calling for a variety of direct and indirect price controls.

One measure floated in Utah would allow patients to import medicines from Canada. That's a bad idea for two reasons.

First, the policy wouldn't lower health care costs. Ninety percent of all drugs sold in the United States are generic, and generics generally cost less in the United States than in Canada. As for brand-name drugs, a patient's co-pay — what he actually pays at the pharmacy — is often lower than the price paid at a Canadian pharmacy, even if the list price of the medicine is higher in the United States.

Second, importation would be dangerous. America has the safest, most secure drug supply chain in the world, thanks to rigorous FDA oversight.

Other countries, even advanced countries like Canada, don't provide the same level of protection. From April 2016 to March 2017, Canadian agents discovered more than 5,500 packages of counterfeit drugs in their midst. Loosening importation restrictions would expose American patients to potentially deadly counterfeit pills.

That's why every FDA commissioner since the Clinton administration has deemed importation a dangerous and unworkable scheme.

Another proposal, from lawmakers in Louisiana, would allow the state to infringe on manufacturers' patents. Creole State legislators want to give generic drug companies the right to make cheap knockoff copies of hepatitis C medicines, which are heavily utilized by the state's Medicaid and prison populations.

This move simply isn't necessary. Multiple drugmakers have introduced competing hepatitis C drugs in recent years. Fierce competition for market share has forced these companies to heavily discount their products. In 2017, Medicaid spending on hepatitis C drugs fell by 28 percent — the biggest drop for any class of medicines.

If states start weakening patent protections, it will have a chilling effect on scientific research. Drug companies won't plow billions in to developing new medicines if the government can break their patents on a whim. Patients would miss out on future treatments and cures as a result of this drop in research. They'd grow sicker. Ironically, that would increase states' long-term health care costs.

This isn't to say that patients aren't paying high prices for drugs. They are. But drugmakers aren't at fault.

Middlemen, like pharmacy benefit managers and insurers, are the ones raising prices on consumers.

Pharmacy benefit managers negotiate drug prices on behalf of health plans. They secure big discounts and rebates on drug prices from manufacturers. But PBMs and insurers routinely fail to pass these savings along to consumers. Instead, they hike consumers' out-of-pocket expenses by forcing them to pay ever-higher co-pays and co-insurance.

If lawmakers want to reduce people's' pharmacy bills, they should demand more transparency from insurers and PBMs. That would drive down prices without jeopardizing consumers' safety or access to medicine.