In the immortal words of President Biden as VP when President Obama signed the Affordable Care Act (Obamacare) into law, this is a big f—kg deal.
For the first time, thanks to President Biden’s Inflation Reduction Act – the historic law lowering health care costs – Medicare is able to negotiate the prices of prescription drugs.
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the first 10 drugs covered under Medicare Part D selected for negotiation. The negotiations with participating drug companies will occur in 2023 and 2024, and any negotiated prices will become effective beginning in 2026. Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs.
“For far too long, pharmaceutical companies have made record profits while American families were saddled with record prices and unable to afford life-saving prescription drugs. But thanks to the landmark Inflation Reduction Act, we are closer to reaching President Biden’s goal of increasing availability and lowering prescription drug costs for all Americans,” said HHS Secretary Xavier Becerra. “Although drug companies are attempting to block Medicare from being able to negotiate for better drug prices, we will not be deterred. The Biden-Harris Administration will continue working to ensure that Americans with Medicare have access to innovative, life-saving treatments at lower costs.”
The Biden-Harris Administration has made lowering prescription drug costs and improving access to innovative therapies a key priority. Alongside other provisions in the new law that increase the affordability of health care and prescription drugs, allowing Medicare to negotiate prescription drug prices will strengthen the program’s ability to serve people with Medicare now and for generations to come. The negotiation process will consider the selected drug’s clinical benefit, the extent to which it fulfills an unmet medical need, and its impact on people who rely on Medicare, among other considerations, such as costs associated with research and development as well as production and distribution for selected drugs. As a result of negotiations, people with Medicare will have access to innovative, life-saving treatments at lower costs to Medicare.
The selected drug list for the first round of negotiation is:
These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023, which is the time period used to determine which drugs were eligible for negotiation. CMS will publish any agreed-upon negotiated prices for the selected drugs by September 1, 2024; those prices will come into effect starting January 1, 2026. In future years, CMS will select for negotiation up to 15 more drugs covered under Part D for 2027, up to 15 more drugs for 2028 (including drugs covered under Part B and Part D), and up to 20 more drugs for each year after that, as outlined in the Inflation Reduction Act.
“We’ve reached this milestone because of the Inflation Reduction Act– one of the most significant laws ever enacted, and one that passed with the leadership of Democrats in Congress,” President Biden stated. “We took on Big Pharma and special interests, overcoming opposition from every Republican in Congress, and the American people won.”
When implemented, prices on negotiated drugs will decrease for up to 9 million seniors. These seniors currently pay up to $6,497 in out-of-pocket costs per year for these prescriptions. In addition, the nonpartisan Congressional Budget Office reports that this will save taxpayers $160 billion by reducing how much Medicare pays for drugs through negotiation and inflation rebates.
“This plan is a key part of Bidenomics, my economic vision for growing the economy from the middle out and the bottom up – not the top down. And it’s working.,” Biden stated. “That’s why Big Pharma has already filed eight lawsuits against my Administration, and spent nearly $400 million last year to try to stop our progress. Let me be clear: I am not backing down. There is no reason why Americans should be forced to pay more than any developed nation for life-saving prescriptions just to pad Big Pharma’s pockets. For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear. That is why we will continue the fight to lower healthcare costs – and we will not stop until we finish the job.”
HHS Announces First Set of Drugs Selected for Medicare Price Negotiation
For the first time ever, HHS announced ten drugs selected for Medicare drug price negotiation:
Commonly Treated Conditions
Total Part D Gross Covered Prescription Drug Costs from June 2022-May 2023
Number of Medicare Part D Enrollees Who Used the Drug from June 2022-May 2023
Average Part D Covered Prescription Drug Costs Per Enrollee
Prevention and treatment of blood clots
Diabetes; Heart failure
Prevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease
These ten drugs are among those with highest total spending in Medicare Part D – $50 billion in total part D gross covered drug cost s- or 20% of total part D gross covered drug costs june 1, 2022, may 31, 2023. More than 8 million Part D enrollees depend on these vital treatments to treat life-threatening conditions including diabetes, heart failure, and cancer, but many struggle to access their medications because of prohibitive costs.
Medicare drug price negotiation will result in lower out-of-pocket costs for seniors and will save money for American taxpayers. Negotiations for the first group of selected drugs will begin in 2023, with negotiated prices going into effect in 2026.
Out-of-Pocket Costs for Drugs Covered Under Part D Selected for Drug Price Negotiation, by State
Today HHS also released a report showing that 9 million Medicare Part D enrollees took the drugs covered under Part D selected for negotiation and paid a total of $3.4 billion in out-of-pocket costs for these drugs in 2022. For enrollees without additional financial assistance, average annual out-of-pocket costs for these drugs were as high as $6,497 per enrollee in 2022.
To view a state-by-state breakdown of the number of Medicare enrollees who use the prescription drugs selected for negotiation and their out-of-pocket costs, visit HHS’s website.
Continuing to Lower Prescription Drug Costs
Every day, millions of seniors are saving money on prescription drug costs because of the Biden Administration’s actions. People with Medicare are saving an average of $70 in out-of-pocket costs on vaccines like shingles and Tdap because President Biden’s Inflation Reduction Act made recommended vaccines free for beneficiaries starting this past January. Nearly four million seniors and others on Medicare with diabetes started to see their insulin costs capped at $35 per month this past January, saving some seniors hundreds of dollars for a month’s supply. And some seniors taking drugs covered under Part B for which manufacturers have hiked prices faster than inflation are saving up to $449 in lower coinsurance this quarter thanks to the new Medicare inflation rebates.
People with Medicare will continue to see their prescription drug costs go down as more provisions of the Inflation Reduction Act go into effect in the coming years. Part D enrollees will no longer pay 5% co-insurance when they reach the catastrophic phase of their benefit starting in 2024. Nearly 19 million seniors and other Part D beneficiaries are projected to save $400 per year on prescription drugs when the out-of-pocket cap drops to $2,000 in 2025, and 1.9 million enrollees with the highest drug costs will save an average of $2,500 per year. And the lower prices negotiated for the high-spend drugs selected today will go into effect in 2026.
The President’s Budget for Fiscal Year 2024 builds upon the Inflation Reduction Act to continue lowering the cost of prescription drugs. For Medicare, this includes further expanding the newly established negotiation authority by extending it to more drugs and bringing drugs into negotiation sooner after they launch. The Budget also includes proposals to curb inflation in prescription drug prices and cap the prices of insulin products at $35 for a monthly prescription in the commercial market to lower drug costs for all Americans.
The ability to negotiate drug prices is historic. For decades, Big Pharma lobbyists (three for every one member of Congress) and Congressional Republicans stopped Medicare from saving taxpaying, hardworking families money by negotiating lower drug costs.
The result of that blockade was that Americans were forced to pay the highest prices for medicines in the world, despite the fact that taxpayers subsidize Big Pharma’s research and development.
“This is a game-changer for Americans who are being overcharged for medicines they need and a game-changer for Medicare because it will spend less taxpayer money to deliver the same benefits,” stated Deputy Press Secretary and Senior Communications Adviser Andrew Bates.
“This comes after President Biden also beat Big Pharma by capping the price of insulin at $35 per month for Medicare recipients. Big Pharma has spent nearly $400 million lobbying to stop these reforms.”
However, as the Biden Administration takes these newest historic actions to lower drug costs for Americans and strengthen Medicare, Congressional Republicans continue to side with Big Pharma’s price gouging and cuts to Medicare benefits instead.
Not only do congressional Republicans want to take the new benefits being announced today away from Americans with repeal legislation (just as they spent years trying to repeal the Affordable Care Act – Obamacare) – they are even siding with Big Pharma’s lawsuits to stop them in their tracks, Bates said.
Congressman Morgan Griffith endorsed their suits, saying, “every drug manufacturer probably ought to sue because it is, on its face, an unconstitutional taking.”
And reporters have frequently noted that in their opposition to this breakthrough for seniors, congressional Republicans are parroting Big Pharma’s talking points and “echoing arguments the pharmaceutical industry has made for years.”
After unsuccessfully voting to block President Biden’s plan to let Medicare negotiate lower drug costs, Congressional Republicans have sought to repeal it, in alignment with Big Pharma. In the midterms, they campaigned on repealing Medicare’s new power but shut their ears to voters’ message back to them.
This summer alone, the Republican Study Committee, which represents over three quarters of House Republicans, unveiled yet another repeal plan.
The handouts Congressional Republicans are pursuing for Big Pharma would explode our deficit, weaken Medicare, and subject more American seniors and families to price gouging for life-saving medicines, Bates said.
“Across the board, the hallmark of congressional Republicans’ trickle-down economic agenda is to increase costs and financial burdens shouldered by hardworking Americans in exchange for welfare payoffs to the super rich and multinational corporations. In this case, Big Pharma.
“Their philosophy is the polar opposite of Bidenomics, which is based on rewarding hard work and growing our economy by growing the middle class. Not leaching off the middle class for an extreme rightwing scheme to redistribute income upward.
“We should be bolstering Medicare’s ability to lower drug costs for families, instead of trying to erase them.
“This fight is far from over. President Biden is pushing to expand Medicare’s capacity to negotiate lower drug costs, which he released a concrete plan for in his budget,” Bates said.
Actions are the latest in a series of steps the Biden Administration has taken to eliminate hidden junk fees and lower prescription drug costs
Today, President Biden announced a series of new actions under a core pillar of his “Bidenomics” agenda to lower health care costs and crack down on surprise junk fees for American families and consumers. Since the beginning of his Administration, President Biden has passed historic legislation to lower health care costs for tens of millions of Americans, took on Big Pharma to finally allow Medicare to negotiate lower prescription drug prices, and took action to eliminate hidden fees in every sector of the economy. Today, the Administration is taking additional steps to continue to deliver on those promises.
The President announced:
The Biden-Harris Administration is cracking down on junk insurance. New proposed rules would close loopholes that the previous administration took advantage of that allow companies to offer misleading insurance products that can discriminate based on pre-existing conditions and trick consumers into buying products that provide little or no coverage when they need it most. These plans leave families surprised by thousands of dollars in medical expenses when they actually use health care services like a surgery. If finalized, the rule would limit so-called “short-term” plans to truly short time periods, close loopholes made worse by the previous administration, and establish a clear disclosure for consumers of the limits of these plans.
The Administration is releasing important guidance on rules against surprise medical billing. Biden-Harris Administration rules are already preventing as many as 1 million surprise medical bills every month. New guidance will help stop providers from gaming the system by evading the surprise billing rules with creative contractual loopholes that still leave consumers with unexpected costs.
The Administration is announcing new steps to protect consumers from unfair medical debt. For the first time in history, the Consumer Financial Protection Bureau, HHS, and Treasury are collaborating to explore whether health care provider and third-party efforts to encourage consumers to sign up for these products are operating outside of existing consumer protections and breaking the law. Medical credit cards and loans often lead to higher costs without consumers fully understanding the risks.
The Department of Health and Human Services is releasing a new report showing that nearly 19 million seniors and other Part D beneficiaries are projected to save $400 per year on prescription drugs when President Biden’s $2,000 out-of-pocket cap goes into effect. It’s also releasing state by state data that demonstrates how seniors across the country are helped by just one element of the President’s robust agenda to lower prescription drug prices.
These actions are the latest in a series of steps the Administration has taken to address hidden junk fees across industries, including: cracking down on bounced check and overdraft fees in the banking industry, which is saving consumers more than $5 billion every year; proposing rules to require airlines to disclose all of their fees up front and successfully pushing a number of airlines to end family seating fees; and mobilizing private sector action to eliminate hidden junk fees for concert and sports tickets.
Cracking down on junk insurance The Affordable Care Act has helped tens of millions of Americans access high-quality, affordable health insurance and protects Americans from being discriminated against because of pre-existing conditions. But actions from the previous administration allowed insurance companies to take advantage of loopholes in the law and sell “junk insurance” plans that evade these protections. These “junk insurance” plans leave families surprised by thousands of dollars in bills, often because the insurance plan claims they have a pre-existing condition that isn’t covered. For example, a man in Montana faced $43,000 in health care costs because his insurance plan claimed his cancer was a pre-existing condition, and a Pennsylvania woman was surprised by nearly $20,000 in bills for an amputation her junk plan refused to cover. Today, the Biden-Harris Administration is proposing rules to crack down on this junk insurance, as part of the latest efforts by the Administration to eliminate hidden and junk fees in every industry across the economy. These actions will reduce scam insurance plans that offer really no insurance at all.
“Short-term” plans must be truly short-term. Under the new rules, if finalized, plans that claim to be “short-term” health insurance would be limited to just 3 months, or a maximum of 4 months, if extended – instead of the 3 years that junk plans can offer today as a result of changes made by the previous administration.
Income replacement “fixed indemnity” plans cannot mimic comprehensive health insurance. Under the proposed rules, plans that want to be exempt from the rules for health insurance — because they are designed to replace lost income when people get sick, rather than provide full medical coverage – have to live up to their original purpose and cannot be designed like comprehensive health insurance. This means that plans would need to make clear that people signing up for these plans would get a defined benefit, like $100 per day of illness, instead of thinking that they have comprehensive insurance. This proposed rule aims to prevent Americans from being on the hook for high medical costs, like a woman who needed an amputation and was left with $20,000 in medical debt because her plan did not include comprehensive coverage.
Plans have to clearly disclose limits. Under the proposed rules, plans are required to provide consumers with a clear disclaimer that explains the limits of their benefits, including to existing consumers currently enrolled in these plans.
Preventing surprise medical billing Before President Biden took office, millions of people received surprise bills for health care they thought was in-network care covered by their health plan. This could include when people need emergency care and are taken to the nearest hospital, or when a pregnant woman delivers her baby at an in-network hospitals only to find out that the anesthesiologist who cared for her is actually out-of-network. These surprise bills can cost people hundreds or thousands of dollars, averaging between $750 to $2,600. The Administration is protecting millions of consumers from surprise medical bills through the implementation of the No Surprises Act, which has already protected 1 million Americans every month since January 1, 2022 from unfair, undeserved out-of-network charges and balance bills.
The Biden-Harris Administration is taking an important next step to protect consumers from surprise medical bills by issuing guidance to clarify that payers cannot use loopholes to avoid surprising billing protections:
Ending abuse of “in-network” designation. Today, some health plans contract with hospitals, but try to claim that they are not technically “in-network” – which can expose consumers to higher payments when they have to make a hospital visit. The Administration today is making clear this is not allowed under federal law: health care services provided by these providers are either out-of-network and subject to the surprise billing protections, or they are in-network and subject to the ACA’s annual limitation on cost-sharing, further protecting consumers from excessive out-of-pocket costs.
Facility fees treated like other health care costs. The Administration is also concerned about an increase in patients being charged “facility fees” for health care provided outside of hospitals, like at a doctor’s office. These fees are often a surprise for consumers. The Administration today is making clear that health plans and providers must make information about these facility fees publicly available to consumers, as well as other price information for services and items they cover or provide. In addition, nonparticipating providers and nonparticipating emergency facilities cannot evade the protections of the No Surprises Act, including the prohibition on balance billing, by renaming charges otherwise prohibited under the No Surprises Act as “facility fees.”
Protecting consumers from unfair medical debt Increasingly, health care providers are signing up patients for third-party medical credit cards and loans to help pay for care. These credit cards often include teaser rates and deferred interest features that lead to higher costs for consumers, and may be offered even when low- or no-cost alternatives, such as zero-interest payment plans, financial assistance, or health coverage may be available. Health care providers may be promoting these products because they could allow providers to get paid faster, outsource servicing and collections costs to third parties, receive a higher payment from consumers who otherwise would pay a discounted price for care, and in some circumstances, receive a share of the interest revenue gained by the third-party financial company.
Use of these products may complicate insurance coverage and the availability of financial assistance, and consumers may not fully understand the risks associated with these products, leading to higher costs and negative impacts on consumers’ financial, physical, and emotional well-being.
For the first time ever, the Consumer Financial Protection Bureau (CFPB), HHS, and Treasury are collaborating on the needs of health care consumers by releasing a Request for Information (RFI) to learn more about this emerging practice and solicit comment on potential policy actions. Part of this RFI will explore whether providers are operating outside of existing consumer protections, because once medical bills are placed on medical credit cards, there may be gaps in how various consumer protections apply.
New data shows nearly 19 million seniors and other Medicare beneficiaries will save an estimated $400 per year in prescription drug costs because of President Biden’s out-of-pocket spending cap Thanks to President Biden’s Inflation Reduction Act, out-of-pocket spending on prescription drugs at the pharmacy will be capped at $2,000 per year for Medicare Part D enrollees starting in 2025. Today, the Department of Health and Human Services (HHS) released data showing that 18.7 million (or 1 in 3) seniors and people with disabilities who are enrolled in Part D plans will save, on average, $400 per year when the $2,000 cap and other Inflation Reduction Act provisions go into effect in 2025. And some enrollees will save even more: 1.9 million enrollees with the highest drug costs will save an average of $2,500 per year starting in 2025. Overall, the law’s Part D benefits provisions will reduce enrollee out-of-pocket spending by about $7.4 billion annually.
To view data broken down by state and demographic, visit LINK.
Today’s actions follow significant milestones achieved last week in implementing President Biden’s historic law to lower health care and prescription drug costs. On June 30, the Centers for Medicare and Medicaid Services released revised guidance that describes how they will negotiate lower prescription drug prices for seniors later this year. The first ten drugs selected for negotiation will be announced by September 1, 2023. Also last week, the $35 monthly cap on insulin for Medicare Part B beneficiaries went into effect. Already 1.5 million Medicare Part D beneficiaries were saving up to hundreds of dollars per month on insulin costs because of the Inflation Reduction Act, and many more will benefit from these cost savings starting this month.
This is a fact sheet from the White House on actions President Biden has taken to lower health care and prescription drug costs:
To mark the start of Medicare Open Enrollment season, President Biden highlighted how seniors can take advantage of the Inflation Reduction Act’s cost-saving provisions as they shop for new health insurance plans. The President also signed an Executive Order directing the Department of Health and Human Services to explore additional actions it can take to lower prescription drug costs to build on his Administration’s work lowering costs for working and middle-class families.
Americans are squeezed by the cost of living – that’s been true for years and is a key reason the President ran. Health care costs in particular are driving inflation. Too many Americans face challenges paying for prescription drugs. On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications. Nearly three in ten American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost.
The Inflation Reduction Act – which President Biden and Congressional Democrats delivered – tackles that problem and locks in on average $800 per year lower health care premiums for 13 million families, lowers seniors’ prescription drug prices, and caps their out of pocket expenses for prescription drugs at $2,000 per year. The Inflation Reduction Act protects Medicare beneficiaries from catastrophic drug costs by phasing in a cap for out-of-pocket costs at the pharmacy, establishing a $35 monthly cap per prescription of insulin, requiring companies who raise prices faster than inflation to pay Medicare a rebate, and allowing Medicare to negotiate prices for high-cost prescription drugs for the first time ever. Republicans in Congress, meanwhile, have said their top priority is to repeal the Inflation Reduction Act, ending these cost-saving provisions and raising prices for tens of millions of Americans.
To further lower health care costs, earlier this week, the Treasury Department took action to fix the so-called “family glitch” rule that was making it harder for families to afford health care coverage for their spouse or child. About 1 million Americans will either gain coverage or see their insurance become more affordable as a result of the new rule.
Lowering Medicare Costs This Open Enrollment Season
Starting this January, seniors and other Medicare beneficiaries will begin to see the benefits of these cost-saving measures. Because of the Inflation Reduction Act:
A month’s supply of insulin will be capped at $35 starting on January 1, 2023.
Medicare beneficiaries will pay $0 out of pocket for recommended adult vaccines covered by their Part D plan, including the shingles vaccine – which costs seniors up to $200.
Prescription drug companies that try to raise their prices faster than inflation will be required to pay Medicare a rebate.
Earlier this year, HHS released a report showing that the price of 1,200 prescription drugs rose faster than inflation in just the last year. For example, one manufacturer of a drug used to treat high blood pressure and heart failure, used by millions of Medicare beneficiaries, increased the drug’s price by nearly 540 percent in 2022. Another drug used to treat autoimmune conditions increased by $1000 just this year.
During Medicare Open Enrollment – running from October 15 to December 7 – seniors and other beneficiaries will be able to choose drug coverage that reflects these new cost-savings, putting money back into their pockets.
Medicare beneficiaries should visit Medicare.gov or call 1-800-MEDICARE to review their options for the coming year, and make sure their health and prescription drug coverage is right for them.
Using HHS’ Innovation Center to Further Bring Down Costs
As the Biden-Harris Administration works to implement the Inflation Reduction Act, President Biden will sign an Executive Order today directing the Department of Health and Human Services to consider additional actions to further drive down prescription drug costs. That includes leveraging the “Innovation Center” at HHS, created by the Affordable Care Act, which has authority to test new ways of paying for Medicare services that improve the quality of care while lowering costs.
Under the Executive Order, HHS will have 90 days to submit a formal report outlining any plans to use the Innovation Center’s authorities to lower drug costs and promote access to innovative drug therapies for Medicare beneficiaries. This action would build on the Inflation Reduction Act’s landmark drug pricing reforms and help provide additional breathing room for American families.
The vigorous contest of Democrats seeking the 2020 presidential nomination has produced excellent policy proposals to address major issues. Vice President Joe Biden has released his plan for ending the opioid crisis and ensuring access to effective treatment and recovery for substance use disorders. This is from the Biden Campaign:
Millions of families are impacted by the opioid crisis. It’s ravaging communities coast to coast, from New Hampshire to California. The challenge of substance use disorders is not limited to opioids. Millions of individuals are affected by misuse of other substances such as alcohol or methamphetamine. Latest estimates indicate that, in 2018, almost 68,000 Americans died from a drug overdose – almost 47,000 of which involved an opioid. And, the impacts of this crisis reverberate in our classrooms and neighborhoods, in small towns and big cities.
But President Trump wants to repeal Obamacare, including its Medicaid expansion. Repeal would be disastrous for communities and families combating the opioid crisis. It is not realistic to think that grant money will fill the hole that eliminating Obamacare and its Medicaid expansion would create.
Step one of Biden’s plan to tackle the opioid epidemic and substance use disorders is to defeat Trump and then protect and build on Obamacare. And, Biden will pursue a comprehensive, public health approach to deal with opioid and other substance use disorders. His plan will:
accountable big pharmaceutical companies, executives, and others responsible
for their role in triggering the opioid crisis.
effective prevention, treatment, and recovery services available to all,
including through a $125 billion federal investment.
overprescribing while improving access to effective and needed pain management.
the criminal justice system so that no one is incarcerated for drug use alone.
the flow of illicit drugs, like fentanyl and heroin, into the United States – especially from China and
HOLD ACCOUNTABLE BIG PHARMA COMPANIES, EXECUTIVES, AND OTHERS
RESPONSIBLE FOR THEIR ROLE IN TRIGGERING THE OPIOID CRISIS
Biden will demand accountability from pharmaceutical companies and others
responsible for the opioid crisis, including manufacturers, distributors, and
“pill mill operators.” Pharmaceutical executives should be held personally
responsible, including criminally liable where appropriate. Specifically, Biden
Direct the U.S. Justice Department to make actions that spurred
this crisis a top investigative and, where appropriate, civil and criminal
enforcement priority. Biden
will make sure the Department has all the necessary resources to complete this
work. Building on the efforts of the Obama-Biden Administration, Biden will also ensure the
Food and Drug Administration takes action when new information reveals harms
from previously approved drugs (including the risk of diversion, or the use of
drugs by an individual other than the one to whom the drug was prescribed),
ensures compliance with risk mitigation strategies, and punishes drug companies
for deceptive practices. And, he will appoint an Opioid Crisis Accountability
Coordinator to coordinate efforts across federal agencies and support the
enforcement efforts of state and local partners.
Direct the Drug Enforcement Administration (DEA) to step up
its efforts to identify suspicious shipments and protect communities. Opioids distributors
knowingly shipped millions of pills to towns with hundreds
of residents, helping trigger the opioid epidemic. Biden will empower the DEA
to stop drug shipments from pharmaceutical companies and their distributors
that create risks of diversion and misuse. Biden will work with Congress to
allow the DEA to act expeditiously when a pharmaceutical distributor fails to
adequately monitor shipments that could pose an “imminent danger” to vulnerable
communities and increase penalties for companies that fail to take action to
stop suspicious shipments. In addition, Biden will direct the DEA to improve
data collection on wholesalers and pharmacies, including prescribing patterns
and suspicious order reports, and to disseminate its analysis to distributors
to prevent problems before they become disasters.
Ban drug manufacturers from providing payments or incentives
to physicians and other prescribers. Pharmaceutical companies work hard to persuade doctors and
other medical personnel to prescribe their products. These companies essentially pay providers to prescribe
opioids and other drugs by, for example, paying providers to speak at or attend
conferences, or consult for their companies. By banning these practices, Biden
will ensure that patients’ lives do not take a backseat to doctors’ bottom lines.
MAKE EFFECTIVE PREVENTION, TREATMENT, AND RECOVERY SERVICES AVAILABLE TO
ALL WHO NEED THEM
Biden has long recognized and led on
efforts to make clear that substance use disorders are diseases, not a
lifestyle choice, and that we need to change how we talk about and treat
substance use disorders to align with this fact.
He knows that the most important step we can take to address substance use
disorders is to ensure that Americans have access to affordable, high-quality
health care, including treatment for mental illnesses and substance use
disorder. That’s why Biden has a plan to
build on the Affordable Care Act and achieve universal coverage. In addition,
Biden will redouble efforts to ensure insurance companies stop discriminating
against people with behavioral health conditions and instead provide the
coverage for treatment of mental illness and substance use disorders that
patients and families need. Congress passed a bipartisan parity law 12 years ago requiring
that this discrimination stop, but the enforcement of parity has been
insufficient. As Vice President, Biden championed efforts
to implement the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act. As President, he will finish the
job by appointing officials who will hold insurers accountable, enforcing our
parity laws to the fullest extent. He will also direct federal agencies to
issue guidance making clear how state officials and the public can file a
complaint when their insurers – or Medicaid – are not
living up to their parity obligations.
In addition, Biden will work to make sure that people experiencing substance
use disorders have access to quality facilities and providers. As President, he
will ensure that the new public option, Medicare, Medicaid, the Indian Health
Service, the Military Health System, and the Veterans Health Administration
accelerate integration of substance use disorder care into standard health care
practice. Biden will double funding for community health centers and expand the
supply of health care providers, for example by growing the National Health Service Corps. And, he
will protect rural hospitals from
payment cuts, give them the flexibility they need to remain open, and invest in
telehealth so people in remote areas can still have access to mental health and
substance use disorder specialists.
Finally, Biden will make sure federal funds are specifically targeted at
improving access to treatment and recovery for opioid and other substance use
disorders, and at preventing these disorders in the first place. As Vice
President, Biden championed passage of the 21st Century Cures Act, which
included $1 billion in funding for states to address the opioid epidemic. That
was a down payment. To deal with the immense scope of the opioid and substance
use disorder crisis, Biden will dramatically scale up the resources available,
with an unprecedented investment of $125 billion over ten years. Funds will be
Pursue comprehensive strategies to expand access to
treatment, particularly in rural and urban communities with high rates of
substance use disorders and a lack of access to substance use disorder
treatment services. Biden will invest $75 billion in flexible grants to states and localities
for prevention, treatment, and recovery efforts. State and local agencies will
also be able to use funds to enhance data systems allowing them to better
target resources to individuals and communities most in need of support. As a
condition for receiving funding, grant recipients will have to provide
long-term, comprehensive strategic plans that address the multifaceted nature
of the substance use disorder crisis. Funds may be used to:
Invest in evidence-based, cost-effective prevention programs
in schools and communities to reduce the development of substance use
Mitigate harms from opioid and other drug use, including
communities will be able to use the funds to implement evidence-based programs
designed to stop the spread of diseases like hepatitis C and HIV, including
syringe service programs, or to scale up innovative programs like the safe station initiative started in Manchester,
New Hampshire, which allows those seeking help to go to fire stations in order
to be connected to treatment and recovery services.
Expand access to ongoing treatment and recovery services. Communities will be
able to use funds to increase access to substance use disorder and mental
health treatment and other services to support long-term recovery, including
peer support networks and recovery coaches, and better integrate primary care
and behavioral health. Recognizing the strong evidence that social supports,
including family support, may have a positive impact on the treatment of HIV, Biden will support the
development of family-centered models for substance use disorder treatment and
Make Medication Assisted Treatment (MAT) available to all
who need it, reaching universal access no later than 2025. MAT (also referred to as
MOUD or Medications for Opioid Use Disorder) is regarded as the gold standard of care for
individuals with opioid use disorder. Yet, less than 50% of substance use disorder
the country offer even one of the FDA-approved medications. The 21st Century
Cures Act, legislation Biden championed as Vice President, provided resources to states designed to expand
access to MAT. Biden will build on this in order to ensure universal
access to MAT for all who need it, including by:
Providing $20 billion for grants to dramatically expand
capacity to administer MAT across the country, especially in underserved
establishing new facilities and developing training programs to increase the
number of professionals able to administer MAT.
Stopping insurance companies from erecting barriers to
coverage of MAT. For
example, insurers have imposed “fail first” protocols which require
prescribers to certify that other therapies were tried before covering MAT.
Insurers also may require that physicians obtain “prior authorization” for MAT
before prescribing it.
Removing undue restrictions on prescribing medications for
substance use disorder. For example, drugs containing buprenorphine were approved by the FDA in
2002 but a relatively small number of doctors or medical
personnel are certified to prescribe them. Biden will ensure that any undue restrictions on prescribing are
lifted and review methadone treatment regulations.
Help first responders and community health providers respond
to overdoses. Biden
will invest $10 billion to provide local communities with the tools needed to
prevent overdoses and respond to emergencies emanating from this crisis.
Ensure local communities have a sufficient supply of
overdose prevention drugs. Naloxone (also known as Narcan)
is a medication that can reverse an opioid overdose, making it a critical tool
in the fight to save lives. Biden will expand grants to states for the purchase
of Naloxone to be distributed to local community actors called upon to respond
to overdoses, including first responders, public health providers, and the
staff at homeless shelters and public libraries.
Demand that drug companies charge a fair price for overdose
drugs, including Naloxone. The Biden Administration will aggressively negotiate a reduction in the
drug’s price, on behalf of the federal government, and state and local
Support first responders. Police officers and firefighters are often the first
on the scene of an overdose. Biden will ensure they are equipped not just with
naloxone, but also with the mental health and resilience support anyone would
need after being exposed again and again to such trauma.
Invest in community-based prevention programs and a major
public education effort to eliminate the stigma surrounding substance use
disorder treatment. Biden
will invest $5 billion in community-based prevention efforts and public
education initiatives including training educators to recognize the signs of
mental health problems and substance use disorders and refer them to
appropriate services. Funds will also support evidence-based education programs
for young people on mental health and substance use disorders.
Expand the pipeline of medical personnel to treat substance
use disorders. Building
on legislation like the Opioid Workforce Act of 2019, Biden will work with
Congress to invest $5 billion to expand medical residencies and access to
education and training for medical personnel in substance use disorder
diagnosis and treatment. Funding will support training for primary care
providers, as well as other members of the health care team, to build an
integrated system of care.
Invest in research by doubling funding for the NIH HEAL (Helping to
End Addiction Long-Term) Initiative. This $10 billion investment will support efforts to improve
treatments for chronic pain.
Provide targeted interventions for particular
will invest $10 billion in efforts specifically designed to support populations
with unique situations or needs. Biden will ensure a portion of this funding
for state and local governments is set aside for Tribal governments. In addition
to expanding veterans’ access to
substance use disorder and mental health treatment, Biden will direct his
Secretary of Veterans Affairs to ensure VA medical personnel are sufficiently
trained in safe prescribing practices and pain treatment. Bidenwill call upon the public health and
criminal justice systems to provide evidence-based substance use disorder
treatment, including MAT, for people during their incarceration and after their
release. Finally, Biden will expand investments to help children suffering from
Neonatal Abstinence Syndrome or Neonatal Opioid Withdrawal Syndrome, and to
ensure their mothers have access to effective treatment and care.
STOP OVERPRESCRIBING WHILE IMPROVING ACCESS TO EFFECTIVE AND NEEDED
An essential part of our national strategy to address the opioid epidemic must
be stopping pharmaceutical companies’ practices that lead to overprescribing.
Yet at the same time, physicians still must effectively treat pain. Chronic
pain is a growing public health challenge with wide-ranging impacts: keeping
individuals out of the workforce, negatively affecting their mental and physical
health, contributing to suicidal ideation, and otherwise limiting their quality
of life. Biden believes we need to pursue two joint goals: eliminate
overprescribing of prescription opioids for pain, and improve the effectiveness
of and access to alternative treatment for pain. Biden will:
Support development of less addictive pain medications and
alternative pain treatments, and improve standards of quality for treatment. We need pain medications
that are less addictive and more effective. Biden will invest in NIH research
to develop these new medications. By doubling funding for NIH’s HEAL program,
Biden will accelerate research regarding alternative treatments and therapies
and help providers and patients better understand the options and access alternatives.
And, he will direct the FDA to give priority to new pain medications with a
documented reduced risk of addiction.
Expand coverage for alternative pain treatments. As documented in a recent study related to back pain,
some non-pharmacological pain interventions (e.g., psychological counseling,
acupuncture, physical therapy, or occupational therapy) are not consistently
covered or have administrative barriers to coverage (e.g., pre-authorization,
visit limits). In accordance with evidence-based medicine, Biden will call for
a requirement that Medicare, Medicaid, his proposed new public option, and
private insurance companies consistently and transparently cover alternatives
to opioids for chronic pain, without barriers such as prior authorization or
high levels of cost-sharing.
Provide training to medical personnel in pain management and
substance use disorder treatment. Building on the Obama-Biden Administration’s prior
Biden will direct the U.S. Department of Health and Human Services to work with
the medical community to support research and the development of curricula and
training regarding pain management. He will ensure that the systematic study of
pain management and substance use disorder is a mandatory part of the curricula
and material on which doctors and other medical personnel are tested. Those
seeking a federal DEA license to prescribe controlled substances will be required to receive training on
proper prescribing guidelines and pain management.
Expand the effectiveness of monitoring programs designed to
prevent inappropriate overprescribing of opioids. Prescription Drug Monitoring
Programs (PDMPs) are electronic databases designed to prevent drug abuse. For
example, a provider can check the database before prescribing in order to
determine whether his or her patient has been getting the same prescription
from multiple providers. In order to receive any of the $125 billion in new
grants under the Biden Administration, states will have to institute a
requirement that every prescriber checks the database every time they write a
new opioid prescription. Biden will also set aside some of these grant dollars
to ensure states improve Prescription Drug Monitoring Programs data-sharing
across state lines.
Ensure regular updating of the Centers for Disease the
Control and Prevention (CDC) prescriber guideline based on the best available
evidence. The CDC
has issued a guideline to help prescribers
make evidence-based decisions regarding when and how to prescribe opioids in
order to minimize the risk of abuse while also effectively treating pain. Biden
will ask the CDC to commit to regularly updating these guidelines as new
evidence emerges regarding opioid abuse risk factors and alternative pain
treatments. And, he will partner with health care providers and states to
maximize providers’ awareness and use of the guideline.
REFORM THE CRIMINAL JUSTICE SYSTEM SO THAT NO ONE IS INCARCERATED FOR
DRUG USE ALONE
Biden has released a criminal justice plan
that will strengthen America’s commitment to justice and reform our criminal
justice system by building a system focused on redemption and rehabilitation.
Biden believes that no one should be incarcerated for drug use alone, and as
President he will treat drug use as a disease rather than a crime.
Specifically, Biden will:
End all incarceration for drug use alone and instead divert
individuals to drug courts and treatment. Biden will require federal courts to divert these
individuals to drug courts so they receive appropriate treatment and services.
He’ll incentivize states to put the same requirements in place. And, he’ll
expand funding for federal, state, and local drug courts and other programs
that divert individuals who commit crimes as a result of or in furtherance of
substance use disorders to treatment rather than incarceration.
Get people who should be supported with social services –
instead of in our prisons – connected to the help they need. Too often, those in need of
mental health care or treatment for a substance use disorder do not get the
care that they need. Instead, they end up having interactions with law
enforcement that lead to incarceration. To change the nature of these
interactions, the Biden Administration will fund initiatives to partner mental
health and substance use disorder experts, social workers, and disability
advocates with police departments. These service providers will respond to
calls with police officers so individuals who should not be in the criminal
justice system are diverted to treatment for substance use disorder or mental
illness, when appropriate, or are provided with the housing or other social
services they may need.
STEM THE FLOW OF ILLICIT DRUGS LIKE FENTANYL, ESPECIALLY FROM CHINA AND
As part of a comprehensive agenda that prioritizes prevention, treatment,
recovery, and harm reduction, Biden believes that part of the solution to the
opioid crisis involves preventing bad actors from smuggling opioids and other
illicit drugs into our country. Specifically, Biden will:
Make fentanyl a top priority in our dealings with
Treasury Department has already sanctioned a small number of Chinese nationals in connection with
fentanyl – it’s a good start, but going after individuals will not alter Beijing’s
thinking long-term. Biden will pressure Beijing to crack down on illicit
fentanyl production in China and stem the flow of the drug into the United
States. Biden will also develop regional strategies in the Asia-Pacific and the
Americas to deal with shifts in the routes and sources of fentanyl in response
to a Chinese crackdown.
Enhance cooperation with Mexican authorities to disrupt the
movement of heroin and fentanyl across the U.S.-Mexico border. Chinese fentanyl is
frequently transshipped through Mexico, and then smuggled across the
border in pure form or combined with
China takes steps to police fentanyl and its precursors, production and
distribution will increasingly shift to Mexico. Biden will pursue strong,
sustained cooperation with Mexican authorities to disrupt suppliers and supply
routes, including the importation of precursor chemicals from China. The Biden
Administration will also provide technical assistance to enhance the Mexican
Post Service’s (SEPOMEX) ability to detect and electronically track shipments
of fentanyl and precursors that come through Mexico. As President, Biden will
repair the damage to U.S.-Mexico ties inflicted by Donald Trump and develop a
common agenda with Mexico that looks beyond our shared border to promote our
shared prosperity and protect U.S. national security interests.
Enforce sanctions on international actors engaged in the
trafficking of illicit drugs like heroin and fentanyl. Biden’s Treasury Department sanctions team will
map the financial institutions and networks that facilitate the distribution of
fentanyl and key precursors and develop sanctions packages based on that
evidence and task the Office of the Director of National Intelligence to
support these efforts with a focus on illicit finance.
Increase cooperation among global law enforcement
will direct U.S. law enforcement agencies to work closely with foreign
counterparts, share threat information, and use technology to assist in
tracking and seizing illicit shipments.
Ensure federal agencies have the tools and resources they
need to stop the flow of fentanyl from abroad. Fentanyl producers have exploited gaps in monitoring through
the U.S. Postal Service (USPS) to flood the U.S. with the deadly product. Biden
will give the USPS the tools and resources it needs to carry out that mandate
and disrupt the large supplies of fentanyl that are sent through the mail
system, working with U.S. Customs and Border Protection. In addition, the vast majority of opioids and
fentanyl are shipped through legal ports of entry—not in between them. Rather
than waste resources building a wall or tearing families apart, Biden will
direct resources to the ports of entry to interdict opioid shipments there.
Combating the Opioid Epidemic and Substance Use
Disorders, Paid for By Making Sure Pharma Pays Its Fair Share
Biden’s $125 billion investment in a comprehensive response to the opioid
epidemic and substance use disorders is paid for by raising taxes on the profits
of pharmaceutical corporations.
WASHINGTON – U.S. Senator Bernie Sanders, running to be the Democratic nominee for president, on July 17 delivered a major address on Medicare for All, coinciding with the 54th anniversary of Medicare being signed into law. In his remarks, Sanders outlined his plan to make health care a human right for all Americans. Here is highlighted transcript of remarks as they were prepared for delivery: – Karen Rubin, News & Photo Features
Thank you all very
much for being here to discuss one of the major crises facing our country.
Let me also thank the dozens of organizations throughout America who
support Medicare for All and the tens of thousands of doctors, nurses and other
health professionals who support my legislation. Let me thank the 14
Senate co-sponsors that we have on this legislation and the 118 Members of the
House who support similar legislation. And mostly, let me thank the
American people who by the millions understand, as I do, that health care is a
human right, not a privilege.
Together, we will end
the international embarrassment of the United States being the only major
country on earth that does not guarantee health care to all of its citizens.
It is not acceptable to
me, nor to the American people, that some 87
million people today are either uninsured or underinsured.
It is not acceptable
to me that we end up spending almost
twice as much as any other major country on health care, while our life expectancy continues to decline
and our healthcare outcomes lag behind many other countries.
Frankly, I am sick and
tired of talking to doctors who tell me about the patients who died because
they were uninsured or underinsured, and walked into the doctor’s office when
it was too late. And we are talking about over 30,000 Americans who die every year because they are uninsured or
under-insured. What a tragedy.
I am sick and tired of
seeing working class families and small
businesses pay far more for healthcare than they can afford, and 530,000 Americans declare bankruptcy each
year because they cannot pay off the outrageous cost of a medical emergency
or a hospital stay. Families should not be driven into financial ruin
because someone in the family became seriously ill. How insane is that?
I am sick and tired of
hearing from Americans who lost loved ones because they could not afford the unbelievably high cost of prescription drugs, or
hearing from constituents who are forced to cut their pills in half due to the
In fact, later this
month, I will be travelling from Detroit, Michigan to Windsor, Ontario with a
busload of Americans who have diabetes in order to purchase insulin in Canada
at one-tenth of the price that they pay in America.
I am sick and tired of
talking with people who are struggling with mental illness but cannot afford the mental health counseling they
I am tired of talking
to people who have teeth that are rotting in their mouths, but cannot afford the high cost of dental care.
Let me be very honest
and tell you that, in my view, the
current debate over Medicare for All really has nothing to do with healthcare.
It has everything to do with greed and the desire of the healthcare
industry to maintain a system which fails the average American, but which makes
the industry tens and tens of billions of dollars every year in profit.
It is about whether we
maintain a dysfunctional system which
allows the big drug and health insurance companies to make over $100 billion in
profits last year, while the top CEOs in that industry made $2.6 billion in
total compensation – all the while 1 out of 5 Americans cannot afford the
prescription drugs their doctors prescribe.
It’s about whether we
maintain a system in which the CEO of the Aetna insurance company, Mr. Mark
Bertolini, received a golden parachute worth nearly $500 million after his
company merged with CVS Health, while elderly people lack the resources to
purchase a hearing aid.
It’s about whether we
maintain a system that allows the former CEO
from Gilead (John Martin) to become a billionaire by charging $1,000 a pill for
a hepatitis c drug called Sovaldi that costs a dollar to manufacture.
Let us make no mistake
about it. The struggle that we are
now undertaking, to guarantee health care to all Americans as a right and to
substantially lower the cost of prescription drugs, will be opposed by some of
the most powerful forces in America – entities that have unlimited amounts of
money. We’re talking about the insurance companies, the drug companies,
private hospitals, medical equipment suppliers, Wall Street and other powerful
Let me make a
prediction. In order to defeat the Medicare for All movement, powerful special
interests will be spending millions on 30 second television ads, full page
magazine ads, and corporate-sponsored “studies” to frighten the American people
about Medicare for All – which is exactly what happened before the passage of
Medicare in the 1960s. They failed then and they’re going to fail now.
And let me give you an
example of the kind of money and power we are talking about.
Over the last 20 years, the insurance industry
and pharmaceutical companies have spent more than $330 million in campaign
contributions and over $4 billion in lobbying to get Congress to do its
The pharmaceutical industry alone has hired
some 1,200 lobbyists – including the former leadership of both political
I find it quite
interesting that Billy Tauzin, the
Republican Congressman who wrote the bill to prevent Medicare from negotiating
for lower drug prices and then went on to become the President and CEO of
Pharma, received over $11.6 million in compensation in 2010.
That’s how business is done in Washington. Well, I have a different vision of what
a rational healthcare system is all about. Instead of massive profits for the drug companies, the insurance
companies and Wall Street, we must provide a healthcare system that provides
quality healthcare to all in a cost effective way.
And that is exactly what Medicare for All does.
legislation, every family in America
would receive comprehensive coverage, and middle-class families would save
thousands of dollars a year by eliminating their private insurance costs as we
move to a publicly funded program.
The transition to the Medicare for All program
would take place over four years. In the first year, benefits to older people
would be expanded to include dental care, vision coverage and hearing aids, and
the eligibility age for Medicare would be lowered to 55. All children under the
age of 18 would also be covered. In the second year, the eligibility age would
be lowered to 45 and in the third year to 35. By the fourth year, every man,
woman and child in the country would be covered by Medicare for All.
Medicare for All will reduce – let me repeat,
reduce — overall health care spending while lowering the number of uninsured
and underinsured people in this country to zero.
We accomplish this
because Medicare for All creates a
system of health care insurance that isn’t designed to generate profits for
insurance and drug companies — it will be a system focused on delivering actual health care. It will save lives, save money, and end the
frustration of endless paperwork, denials, and desperate fights with an
insurance company to cover medically-necessary medications and procedures.
Medicare for All will
fully eliminate health insurance premiums, deductibles and co-payments. Make no
mistake about it: These are nothing less than taxes on the middle class.
And when we do that, the
average middle class family will save an estimated $3,000 each and every year.
Further, unlike the
current dysfunctional system, Medicare for All allows people the freedom to
choose any doctor, clinic, and hospital without worrying about whether their provider is in-network or
not. People will be able to make
the health care choices that are best for themselves and their families without
some insurance bureaucrat telling them which providers they can see or not
see. Medicare for All is at the end of the day empowering patients and health
In addition, a
Medicare for All system will allow us to
address the serious problem of medically underserved areas.
Just to demonstrate
how absurd our health care system is, I was in Philadelphia two days ago
rallying with the people of that city to try to stop the closure of Hahnemann
University Hospital, an important, safety net hospital in that community.
Why do the owners want to close this hospital? Because they can make more
money redeveloping that property into condominiums and hotels.
Let me address some of
the half-truths, misinformation, and, in some cases, outright lies that people
may be hearing about Medicare for All.
Medicare for All
critics tell us that Americans just love their private health insurance
companies. We heard this most recently from UnitedHealth CEO David Wichmann,
who by the way, made $83 million in 2017 and who said Medicare for All would
“destabilize the nation’s health system.”
But let’s remember: the current system is already disrupting
and destabilizing millions of people’s lives. In the current system, 50 million
Americans every year lose their existing health insurance when their employer
changes insurer, when they change jobs, or when they cannot afford their current
plan. For many of them, they will no longer be able to see the doctor they have
relied on for years. For others, important treatments for long-term
conditions or disabilities will be changed or stopped altogether.
Here is the simple
truth. The American people do not like their private health insurance
companies. In fact private health insurance companies are quite unpopular.
What the American people do like are their doctors, nurses and other
health care providers.
While our opponents
claim that Medicare for All is too expensive, the reality is that it is much more cost effective than our
The Center for
Medicare and Medicaid Services estimates that, if we do not change the system, this country will be spending $50
trillion over the next ten years –19.4 percent of our nation’s GDP.
This is unsustainable and will be incredibly harmful to the people of our
country, to the business community, and to the entire economy.
And the reason why we spend so much is obvious. It
is not just the huge profits in the insurance industry and the pharmaceutical
industry, but it is the incredible and wasteful bureaucratic maze developed by
thousands of different healthcare plans. Today, hospitals and doctors
must deal with patients who have different deductibles, different co-payments,
different networks of coverage, and different coverage for pharmaceuticals, or
no insurance at all. All of this is not only driving doctors and nurses
and hospital administrators to distraction, but it is wasting
up to $500 billion a year on unnecessary administrative costs.
Unlike our current
system, there is broad consensus – from conservative to progressive economists
– that Medicare for All would result in substantial savings to the American
people. Two of the most recent studies on this issue have estimated that Medicare
for All would save the American people between $2 trillion and $5 trillion over
a 10-year period.
Let us be clear, the
fight against Medicare for All today is not a new development. Powerful
special interests have always opposed healthcare programs that work for the
people and not for corporate interests.
Let us not forget that
when President Harry Truman first proposed a program guaranteeing health care
to seniors that idea was billed as radical, “un-American,” and an attack on
basic freedom. And because of that assault, the idea stalled in Congress for
years — until voters made their voices heard.
In 1960, America
elected John F. Kennedy after he campaigned in support of Truman’s idea. That
election prompted serious work on universal health care bill, and Kennedy at
the time noted that “what we are now talking about doing, most of the countries
of Europe did years ago.”
Finally, following the
1964 Democratic election landslide, the new Congress was able to pass what is
now known as Medicare despite intense opposition from the health insurance
industry and the pharmaceutical companies.
More than a
half-century after that achievement, the time is now to go forward. The
time is now to expand Medicare to every man, woman and child in this
Let us be very clear.
When it comes to health care, the insurance and drug industries have been
able to control the political process.
If we are going to break the stranglehold of
corporate interests over the health care needs of the American people, we have
got to confront a Washington culture that is corrupt, that puts profits before
That is why I am
calling on every Democratic candidate in this election to join me in rejecting
money from the insurance and drug industries. That means not accepting
donations over $200 from health insurance or pharmaceutical company PACs,
lobbyists or executives. Candidates who are not willing to take that pledge
should explain to the American people why those corporate interests believe
their campaigns are a good investment.
Of course, President Trump should do the same but I am not going
to even waste my breath suggesting that he will. His efforts to throw 32
million people off their health insurance to have it replaced with junk
insurance shows exactly what side he is on.
Finally, let me say,
eliminating health insurance and drug company money from the Democratic primary
won’t solve all the problems, but it is an important step forward. Now is the
time to tell the health care industry that your profits are not more important
than the lives of the American people.
How much is it worth to you to save your child’s life? $1 million? $10 million? How much is it worth it to you to have the medication that will prolong your mother’s life from Multiple Myeloma, $10,000 a month? (That’s what the medication cost.)
The issue was most recently dramatized by Mylan, the drug company that has a monopolistic control over the EpiPen syringe, and over the course of but a few years, increased the price for an item that can mean the difference between a child surviving a severe allergic response from $57 to $600 (did I mention it has a year-long shelf life?)
The cost of the actual medication, epinephrine, that can stop potentially fatal anaphylactic shock that’s in the EpiPen dispenser? $1.
It’s not just families who are held up, in much the same way as a gun-wielding robber (“Your money or your life”), but school districts, volunteer fire departments and municipalities who can face a severe budgetary crunch.
And it’s not as if Mylan hasn’t already squeezed the profit out of its drug technology – as rapidly as the price has risen, so have the salaries and bonuses paid to its executives.
The steep increase in prices started when drug company Mylan acquired the rights to the EpiPen nearly a decade ago (the company did not even invest in its development). As they hiked the prices, the salaries of their top executives skyrocketed: From 2007 to 2015, Mylan CEO Heather Bresch’s total compensation went from $2.5 million to 3,456 to $18,9 million, a mind-blowing 671% increase.
“I am a for-profit business. I am not hiding from that,” Bresch declared. Indeed, Mylan also dodges paying taxes in America, by using the insidious “inversion” loophole.
In other words, Mylan charges more because it can. Its sole aim is to maximize return for management and investors.
About 40 million Americans have severe allergies to spider bites, bee stings and foods like nuts, eggs and shellfish. Last year, more than 3.6 million U.S. prescriptions for two-packs of EpiPens were filled, earning Mylan nearly $1.7 billion.
What was Mylan’s CEO’s response to the outcry? Mylan said it would expand eligibility for patient assistance, with a $300 savings card.
Mylan is only the latest example. A year ago, the rage was focused on Martin Shkreli, the founder and former chief executive of Turing Pharmaceuticals, who raised the cost of a life-saving drug (which had been available for years from a company he acquired) from an affordable $13.70 a tablet to $750 per tablet.
Another company, Valeant Pharmaceuticals International similarly raised prices of many of its drugs exponentially, including two heart medications, Nitropress and Isuprel used to treat cardiac arrest, and another to treat Wilson’s disease, a rare genetic disorder.
The cynical way they dodge this despicable behavior is to suggest that the consumers don’t actually pay the sticker price – health insurance or Medicare Part D does, or in some cases (as the advertisements like to scream), they offer some relief to the poorest patients. But the upshot is that the rest of us (“society,” if you will) still do pay because of higher premiums. Also, because insurance premiums are so costly, people are opting for cheaper policies that have higher deductibles, so a family might be out-of-pocket to begin with until insurance kicks in.
What is more, the ones who are hurt the most are those who can least afford it: “One of the cruelties of drug pricing is that the burden falls most heavily on those least able to pay it. Uninsured patients often must pay the list price of a drug, and an increasingly large share of insured customers are being asked to pay a percentage of the list price,” writes Katie Thomas in the New York Times. She quotes Pembroke Consulting’s Adam J. Fein, “We soak the poor.”
Not to mention the “donut hole” that many seniors find themselves in. Seniors are finding their costs rising by double digits, 10% in 2015 and 12% in 2014.
There are laws against price-gouging– for food, water, gasoline. There are regulations that keep utility prices – for water, water treatment, electricity – in check, where price hikes have to be justified. Why are there no checks on drug companies, beyond public shaming (which does not seem to work).
The argument is that it costs millions, even a billion dollars and years to research, develop, test and bring a drug to market and many drugs never win approval so never make it to market at all. Well, it also costs millions, even billions, to create a utility system. What is more, taxpayers already pay for a lot of that research, funding programs through universities. (My idea is that taxpayers should be shareholders in the company and get reimbursed through a percentage of the profits on the drug.)
President Obama can use his executive authority to help break Big Pharma’s monopoly power. The FDA controls whether companies can offer alternatives to products like EpiPens, and the National Institutes of Health can prevent new ones from being granted.
Medicare should be allowed to negotiate drug prices (presently inexplicably prohibited under George W. Bush era legislation written by Big Pharma). The Centers for Medicare & Medicaid Services has proposed 6 pilot projects to test possible reforms to how prescription drugs are reimbursed and how the “value” of a drug is measured under Medicare Part B.
Meanwhile, in Congress, Senator Bernie Sanders and Rep. Elijah Cummings of Maryland have introduced bills that would authorize the Secretary of Health and Human Services to negotiate drug prices and reduce barriers to the importation of lower-cost drugs from Canada and other countries.
Another measure being floated in Congress would require a drug company to show justification for any annual price hike greater than 10% (consider that the inflation rate has been running 2%).
But in the absence of Congressional action, California is proposing The California Drug Price Relief Act, which would prohibit the state from paying more for a prescription drug than the lowest price paid for the same drug by Veterans Affairs, which already negotiates lower prices for pharmaceuticals.
“It is no surprise that the pharmaceutical industry already has dedicated $50 million to defeat this ballot initiative,” Sanders said. “Their greed has no end.”
Prices for prescription medicine in the United States soared last year more than 10 percent – the third consecutive year of double digit price increases. One out of five adults between the ages of 18 and 64 – more than 35 million Americans (that’s one out of five)– cannot afford the medications that their doctors prescribe.
Price gouging on life-saving drugs is only one glaring example of why it is an absurdity to operate the health care system as a purely capitalistic, free-market commodity – and yet, this is exactly what is presented by candidates Donald Trump, who vows to repeal Obamacare and the Libertarian Gary Johnson, who thinks that what is wrong with health care system is that there isn’t enough free market forces at work, while Green Party candidate Jill Stein, an actual doctor, has said that the science on childhood vaccinations isn’t definitive.
Hillary Clinton actually has a detailed policy prescription:
Clinton would convene representatives of Federal agencies charged with ensuring health and safety and fair competition, and create a dedicated group charged with protecting consumers from outlier price increases. They will determine an unjustified, outlier price increase based on specific criteria including: 1) the trajectory of the price increase; 2) the cost of production; and 3) the relative value to patients, among other factors that give rise to threatening public health.
Should an excessive, outlier price increase be determined for a long-standing treatment, Clinton’s plan would make new enforcement tools available including:
Making alternatives available and increasing competition: Directly intervening to make treatments available, and supporting alternative manufacturers that enter the market and increase competition, to bring down prices and spur innovation in new treatments.
Emergency importation of safe treatments: Broadening access to safe, high-quality alternatives through emergency importation from developed countries with strong safety standards.
Penalties for unjustified price increase to hold drug companies accountable and fund expanded access: Holding drug makers accountable for unjustified price increases with new penalties, such as fines – and using the funds or savings to expand access and competition.
As it is the system is designed to impede research and development into new drug treatments for ailments and diseases that would not have a big enough pay-back (for example, rarer diseases).
The Obama Administration has supported an initiative which focuses on precision medicine – that is, matching appropriate treatments to genetic make up (it’s why certain asthma treatments are less effective for African-Americans and Hispanics than Caucasians), and how certain cancer treatments (such as envisioned in Biden’s Cancer Moonshot) can be much more targeted.
The Health Care Industrial Complex, however, is not designed to prevent or cure, but prolong the stream of profits.
Hillary Clinton has announced a new plan to protect Americans from unjustified price hikes of long-available prescription drugs with limited competition, like EpiPens and pyrimethamine, the drug for a disease related to AIDS that Turing Pharmaceuticals raised the price of by more than 5,000%. After speaking out against excessive prices for prescription drugs throughout the campaign and, last week, calling for Mylan to lower its EpiPen price, Clinton believes that Mylan’s recent actions have not gone far enough to remedy their outrageous price increase. So today, Clinton is proposing a new set of strong tools – including a consumer protection group – that will let the government take effective action in such cases where public health is put at risk by an unjustified, outlier price increase for a treatment long available on the market with limited competition.
“Over the past year, we’ve seen far too many examples of drug companies raising prices excessively for long-standing, life-saving treatments with little or no new innovation or R&D,” Clinton said. “It’s time to move beyond talking about these price hikes and start acting to address them. All Americans deserve full access to the medications they need — without being burdened by excessive, unjustified costs. Our pharmaceutical and biotech industries are an incredible source of American innovation and revolutionary treatments for debilitating diseases. But I’m ready to hold drug companies accountable when they try to put profits ahead of patients, instead of back into research and innovation.”
Today, building off the comprehensive plan she offered earlier in the campaign last year, Clinton is calling for action to protect consumers from unjustified prescription drug price increases by companies that are marketing long-standing, life-saving treatments and face little or no competition. She’ll start by convening representatives of Federal agencies charged with ensuring health and safety, as well as fair competition, to create a dedicated group charged with protecting consumers from outlier price increases. They will determine an unjustified, outlier price increase based on specific criteria including: 1) the trajectory of the price increase; 2) the cost of production; and 3) the relative value to patients,among other factors that give rise to threatening public health.
Should an excessive, outlier price increase be determined for a long-standing treatment, Clinton’s plan would make new enforcement tools available including:
Making alternatives available and increasing competition: Directly intervening to make treatments available, and supporting alternative manufacturers that enter the market and increase competition, to bring down prices and spur innovation in new treatments.
Emergency importation of safe treatments: Broadening access to safe, high-quality alternatives through emergency importation from developed countries with strong safety standards.
Penalties for unjustified price increase to hold drug companies accountable and fund expanded access:Holding drug makers accountable for unjustified price increases with new penalties, such as fines – and using the funds or savings to expand access and competition.
Her plan will establish dedicated consumer oversight at our public health and competition agencies. They will determine an unjustified, outlier price increase based on specific criteria including: 1) the trajectory of the price increase; 2) the cost of production; and 3) the relative value to patients, among other factors that give rise to threatening public health.
In combination with her broader plan – which addresses the costs facing consumers from both long-standing and patented drugs – these new tools to address price spikes for treatments available for many years will lower the burden of prescription drug costs for all Americans.
This plan would impact the many examples we’ve seen over the past year of drug companies raising prices excessively for drugs that have been available for years – from Turing raising the price of pyrimethamine for AIDS patients by over 5,500 percent, to Mylan raising the price of the EpiPen by more than 400 percent. This is not an isolated problem: Between 2008 and 2015, drug makers increased the prices of almost 400 generic drugs by over 1,000 percent. Many of these companies are an example of a troubling trend—manufacturers that do not even develop the drug themselves, but acquire it and raise the price.
The immediate protections she is offering today build on her broader plan to lower prescription drug costs for all Americans that she released last year.