President Trump misunderstands what government drug price negotiations entail
By Peter J. Pitts
President Trump recently pledged to let federal officials negotiate the prices of drugs covered under Medicare. He claims this will save taxpayers billions of dollars.
Nobody doubts that Trump and his team are shrewd negotiators. But the sorts of "negotiations" that Trump refers to have nothing in common with haggling over a real estate deal. Instead, the action that Trump has proposed — repealing the non-interference clause, originally drafted by Democratic Senators Ted Kennedy and Tom Daschle — would result in Medicare drug prices going up and patient choice going down.
This clause has been the key to Medicare's success. Between 2004 and 2013, the Medicare "Part D" prescription drug benefit program cost an extraordinary 45 percent less than initial estimates. Premiums for the program also are roughly half of the government's original projections. These unprecedented results are largely due to Part D's market-based structure. Beneficiaries are free to choose from a slate of private drug coverage plans, forcing insurers to compete to offer the best options to American seniors. This year, seniors can choose from among 746 plans nationwide, with an average monthly premium of around $35.
Such great choice and low costs have led to widespread support for the program. In fact, nine out of ten seniors report satisfaction with their Part D coverage, according to a recent survey.
Through their own negotiations with drug makers, private insurers that offer Part D plans have had great success in keeping pharmaceutical prices down. In fact, the Congressional Budget Office observed that Part D plans have "secured rebates somewhat larger than the average rebates observed in commercial health plans." The non-interference clause prohibits government officials from intruding in these negotiations.
Doing away with the non-interference clause, on the other hand, "would have a negligible effect on federal spending." In a report from 2009, the CBO reiterated this view, explaining that such a reform would "have little, if any, effect on [drug] prices."
In fact, allowing the feds to negotiate drug prices under Part D likely would have a negative effect on the program. The CBO explains that to achieve any significant savings, the government would have to follow through on its threats of "not allowing [certain] drug[s] to be prescribed."
In other words, the government might drop some drugs from Medicare's coverage. Patients who need those drugs would then be forced to pay for them out-of-pocket, which would make medicines vastly more expensive for the seniors that Trump wants to help.
If patients couldn't afford the prescription, then they might switch to a less effective drug or stop taking the medicine altogether. Their health would suffer.
Unfortunately, this isn't a hypothetical consequence. Just look at what's happening with the Veterans Affairs formulary, which permits government interference. The VA covers barely 80 percent of the 200 most popular drugs in the country. Medicare, which doesn't allow for government meddling, covers 95 percent of these medicines.
Letting Medicare go the way of the VA would be devastating for seniors. Senators Kennedy and Daschle knew what they were talking about. The president should pay close attention.
Peter J. Pitts, a former FDA associate commissioner, is president of the Center for Medicine in the Public Interest.