New Congress must address drug affordability

Now that the midterm elections are over and control of Congress has moved from the Republicans to the Democrats, people are seeking clarity about what this change will mean for public health programs.

That was the word from a panel of Avalere Health experts who conducted a webinar on what the new Congress could do for Medicare and prescription drug pricing.

“It is fair to say that rising costs were important to voters and drove a lot of what happened in the election,” said Elif Alyanak, Avalere’s managing director for vaccine policy. “There has been a lot of interest in drug pricing for some time and it has been a key policy point.”

Now that the midterms are over, Democrats in Congress and the Trump administration will compete to prove to voters that they are the party of drug pricing reform, she said.

“We will enter into two years of an arms race to outduel the other party and try to convince voters that they are the champions of making drugs affordable,” said Matt Kazan, Avalere Health senior vice president.

Kazan said congressional Democrats are likely to release their plans for what the Medicare drug pricing program could look like in 2028. They will go to voters and say what they are doing in this space. Meanwhile, the administration will compete with Democrats through policy levers they have available, such as most-favored-nation agreements.

Democrats are considering what expanding or reforming drug price negotiations would look like, he said. Such legislation isn’t likely to become law over the next two years, but if Democrats take control of Congress and the White House in 2028, such legislation could be a starting point.

Unlikely but not unthinkable

A Medicare Part D public option may be politically unlikely today – but it’s not unthinkable, the panelists said.

Kazan said although congressional Democrats “have moved to the left on healthcare issues,” they also are invested in a robust Medicare fee-for-service program. “ You can’t have a strong fee-for-service program without a strong Part D program.”

Pharmacy benefit manager reform is still an issue, with states looking at compensation, fiduciary responsibility and vertical integration – with particular emphasis on vertical integration.

Leadership at the U.S. Department of Health and Human Services might change, but Alyanak said the damage has been done. She pointed to the long-term consequences of outbreaks of diseases once kept under control by vaccines, as well as cuts to federal health research grants.

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Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at susan.rupe@innfeedback.com.