Federal Court puts brakes on Medicare negotiating drug prices

Over two months ago, as supporters of President Biden's Inflation Reduction Act (IRA) celebrated the one-year anniversary of the passage of the historic legislation, the U.S. Chamber of Commerce, Pharmaceutical Research and Manufacturers of America (PhRMA), along with drugmakers filed multiple lawsuits to block the IRA's drug price negotiation provisions. The drug price negotiation program, created by IRA, allows Medicare to use its bargaining power to negotiate the prices often prescription drugs for the first time. The multiple-filed legal suits came weeks before Sept. 1 when the Medicare & Medicaid Services (CMS) was scheduled to publish a list of the first 10 drugs that would be subjected to negotiations. These lawsuits argued that the federal price negotiation program was unconstitutional because it violated the First and Fifth Amendments of the U.S. Constitution, as well as the separation of powers clause, by giving the U.S. Department of Health and Human Services (HHS) discretion over a maximum fair price for any given drug selected for negotiation. These lawsuits also charge that CMS price controls would force drug makers to pull back on developing new drugs, jeopardizing medical breakthroughs for individuals with life-threatening and chronic illnesses. Among the nine lawsuits scheduled to go to trial, one was a motion filed on July 12, 2023 by the Chamber and several of its affiliates in Ohio. This motion requested the court to issue a preliminary injunction to halt the Medicare drug negotiation program from implementation. The ruling came before the Oct. 1, 2023 deadline requiring drugmakers whose pharmaceuticals were selected for negotiations to either sign agreements to participate or to face stiff penalties.

The U.S. Department of Justice opposed the Chamber's motion, filing a motion to dismiss its case. On Sept. 15, 2023, the court held oral arguments giving the Chamber and the DOJ an opportunity to present their legal arguments in greater detail. Overcoming a Major Legal Hurdle On Friday, September 29, 2023, U.S. District Judge Michael J. Newman for Southern District of Ohio, denied the Chambers request to block implementation of the newly established Medicare drug price negotiation program before the drug price negotiation talks began. The ruling called on the Chamber to file an amended complaint by Oct. 13, 2023. DOJ would then have until Oct. 27, 2023 to renew its motion to dismiss. According to Spencer Kimball of CNBC, legal experts say the pharmaceutical industry hopes to see conflicting rules from lawsuits filed in other federal appellate courts to bring this issue to the Supreme Court for final resolution. The Willimantic, Connecticut-based Center for Medicare Advocacy (CMA), a nonprofit group pushing for comprehensive Medicare coverage, health equity and quality of health care for seniors and people with disabilities, is encouraged bv Judge Newman's ruling, which assessed the drug manufacturer's claims "to be weak in the face of clearly established laws." According to CMA, the 28-page court order found that the Chamber and other plaintiffs had demonstrated neither likelihood of success on the merits, nor irreparable harm, which are required for a preliminary injunction. CMS noted that this case cited "clear" law that "participation in Medicare, no matter how vital it may be to a business model, is a completely voluntary choice." The court also found that the price established by negotiations cannot be considered 'confiscatory,' as the Chamber charges or "a violation of due process, because drug manufacturers can opt out of Medicare entirely." Newman's ruling noted that drugmakers are not compelled to sell drugs at the prices established by the Medicare program and that any economic harm, when the negotiated drug prices take effect in 2026, was too speculative to warrant immediate relief, reported CMS. However, the court did deny the government's motion to dismiss the lawsuit entirely, saying that more information on whether the plaintiffs have standing to sue would be beneficial and therefore the judge is allow ing for limited discovery to clarify issues related to legal standing, after which the government may renew its motion to dismiss, noted the Medicare advocacy group.

With this ruling, Medicare may move forward with its implementation of its drug negotiation program as this case and others continue to proceed. Giving their two cents.. At press time, the Chamber did not respond to a request for comment about the court's ruling. But health care and aging advocacy groups issued statements expressing their thoughts about the impact of Newman's ruling. "This is the first major blow to Big Pharma in its legal battles to block the drug price negotiation provisions under the Inflation Reduction Act, says Peter Maybarduk, Public Citizen's director of the Access to Medicines program. "The Chamber's lawsuit lacks merit; the court made the right decision not to grant the injunction, which would have caused needless patient suffering and treatment rationing, notes Maybarduk, calling on drugmakers "to drop their lawsuits and drop their prices." "Now, drug companies should agree to participate in the negotiation program in good faith. The program is an important first step in ending the exorbitant prices charged to Medicare enrollees," adds Maybarduk. Frederick Isasi, Executive Director of Families USA, happily noted that "the Medicare drug negotiation program continues, calling the ruling "a big win for seniors and their ability to purchase life-saving medications." "The ability to afford medication is a matter of life and death for millions of older adults. That's why we are fighting this David and Goliath battle -people deserve to pay a fair price for their drugs and Medicare price negotiation is a critical piece of this puzzle. And let's not forget each drug subject to fair price negotiation is an old drug that millions of people need and doesn't have competition," he notes. "It never ceases to amaze us that -on one hand -Big Pharma can cry poverty by saying that drug negotiations will hurt their bottom line, while recent earnings reports show they are raking in money hand over fist. We are glad Judge Michael J. Newman, a Trump appointee in Ohio's Southern District, saw through this hypocrisy by affirming the Biden administration's power to begin negotiating the prices of 10 medications with drugmakers," says Dan Adcock, Director of Government Relations and Policy, of the Washington, DC-based National Committee to Preserve Social Security and Medicare. (NCPSSM).

According to NCPSSM, Drug makers made a whopping $493 billion in revenue from ten drugs that are now subject to price negotiations between CMS and the manufacturer, which have accounted for more than $170 billion in gross Medicare spending, according to a report from the nonprofit, Protect Our Care. "The court's decision to allow Medicare drug price negotiations to move forward is welcome news, says William Alvarado Rivera, Senior Vice President for Litigation at AARP Foundation. "Pausing Medicare negotiations would have risked billions of dollars in savings for taxpayers -and countless lives. It is unconscionable that Americans face such high prescription drug costs that many people skip taking medication altogether or must ration it," he said. "We're prepared to fight for as long as necessary to ensure big drug companies can't charge excessive prices at the expense of patients' health, says Rivera, noting that the new Medicare negotiation law would bring financial and medical relief to millions of older Americans and their families, and put drugs that treat life-threatening and chronic conditions, from cancer to heart disease, within their reach.Rivera says, "It must not be derailed." Congress has put the brakes to the spiraling costs of pharmaceuticals by giving Medicare the authority to negotiate the price of popular drugs with drug makers. America's seniors will continue to suffer financial hardships and many might even lose their lives by not choosing not to take their costly medications if courts rule in favor of drug companies. Time will tell. Herb Weiss, LRI 12, is a Pawtucket-based writer who has covered aging, health care and medical issues for over 43 years. To purchase his books, Taking Charge: Collected Stories on Aging Boldly and a sequel, compiling weekly published articles, go to herbweiss.com.