For a while, lawmakers of both major parties have been getting an earful from Americans about the steeply rising cost of prescription drugs.
But now, Congress is trying to shine a light on one factor in that situation: the middlemen that connect pharmaceutical manufacturers, insurers and patients.
U.S. Rep. Abigail Spanberger, D-7th, sounds hopeful that a unanimously endorsed bill will provide insight into how pharmacy benefit managers’ actions could be driving up patient’s out-of-pocket costs for pharmaceuticals.
The week before last, the U.S. House of Representatives voted 403-0 to pass Spanberger’s bill to make prescription-drug price negotiations more transparent and address the affordability crisis in Central Virginia and across the nation.
“This has been a major issue for me since the campaign began, and since I got elected,” Spanberger said in an interview Friday. “It’s a driving force, because it’s what I hear about. It’s really significant.”
Even as consumer drug costs have skyrocketed, gross profits taken by pharmacy benefit managers rose to an estimated $22.6 billion in 2016, according to Spanberger’s office.
The nation’s three largest PBMs—Express Scripts, CVS Caremark and Optum Rx—control nearly three-quarters of the U.S. prescription-drug supply chain.
Yet, patients and pharmacists cannot see the rebates and discounts that these middlemen get. That means consumers are unable to learn more about how the managers could be causing drug prices to rise.
To remedy that situation, Spanberger introduced the Public Disclosure of Drug Discounts Act with a bipartisan group of colleagues.
It sailed through the House—an unusual event for any legislator, especially a freshman.
“In our effort to build a broad consensus, we ended up building a unanimous consensus,” the Henrico Democrat said. “I have only been in Congress since January, but I will tell you that does not happen frequently.”
Spanberger said she hopes the Senate will vote on and pass the bill, and that the president will sign it into law.
“The secretary of health and human services has tweeted about our bill, said he was excited, and congratulated us on it,” she said. “There is a real interest in this effort, and I am very proud of that.
Spanberger thanked Reps. Jodey Arrington, R-Texas, Brendan Boyle, D-Pa., Elissa Slotkin, D-Mich., Frank Pallone, D-N.J., Richard Neal, D-Mass., and Jan Schakowsky, D-Ill., for partnering on the legislation. The House Energy & Commerce and Ways & Means committees advanced the bill to speed it to a floor vote.
“This bill is an example of getting support from both sides of the aisle and creating a sustainable policy, no matter what administration in place,” she said. “When the Senate is looking at what it wants to pursue, the fact that there is a bill on prescription drugs that passed the House of Representatives with a vote of 403 to zero, ideally the sensible thing would be to prioritize such an effort.”
The bill would help hold PBMs accountable, requiring them to report their aggregate prescription-drug rebates, discounts and other price concessions to a public website. The heightened market transparency would help patients, pharmacists, employees and business owners better understand and compare the discounts that PBMs receive from drug manufacturers.
The bill met with no notable opposition, and would not impose any additional burden on companies, Spanberger said. The pharmaceutical industry already provides pricing data to the federal government. Her bill would just make it public, she said.
“I’m excited about it. This an example of us focusing on the things that are most important to people in our district, and nationwide, frankly,” the congresswoman said. “... Everyone, including the president, talks about the cost of prescription drugs and the impact that has on everyday Americans.”
In August, Spanberger held a roundtable in Henrico County with patients, pharmacists and healthcare providers to discuss the issue.
“The pharmacists would tell heartbreaking stories of families, of people, coming into fill their prescriptions, and just leaving them, because they can’t afford them,” she recalled. “For financial reasons, they were walking away from medication that their doctor had prescribed.
“Also, for some of our smaller, family-owned pharmacies, they’ve started not filling a prescription until the patient comes in to pick it up, to make sure they know what the prescription will cost, before they lose their inventory and bear the brunt of that cost.”
On Oct. 28, Spanberger spoke on the House floor and urged fellow legislators to support her bill, mentioning the healthcare roundtable and other conversations with her constituents.
“In every community in the Seventh District of Virginia—from Chesterfield to Culpeper, the extremely personal effects of rising prescription drug costs are on full display,” she said. “Whether at a coffee shop, a town hall, or a street fair, I always hear yet another heartbreaking story from a mother, father, grandparent, or young adult struggling to afford their prescription drugs. People genuinely feel helpless, and it’s due to no fault of their own.
“In many cases, steep costs have forced them to make nearly impossible decisions. A costly, lifesaving medication could mean buying fewer groceries for their family. It could mean reluctantly selling their home. And it could mean saving less—or nothing at all—for their retirement or their kids’ education.
“And even for those who are healthy, there’s an overwhelming fear: ‘What if I get sick—or what if a loved one gets sick—and we can’t afford the medication?’”
In addition to her drug-discount disclosure legislation (H.R. 2115), Spanberger has introduced another bipartisan bill that would get “biosimilars”—the generic version of biologic medications—to market faster, ensuring more options for patients and more competition among drugmakers.
Spanberger’s Biologic Patent Transparency Act would help stop the practice of “patent gaming” that blocks new generic alternatives from entering the consumer market.
Derived from living organisms, biologic medicines are used to treat many diseases and chronic conditions, including cancer, diabetes and autoimmune diseases. Manufacturers protect them by using “patent thickets” to block competition and deter competitors from offering the lower-cost alternatives known as “biosimilars,” the Democrat’s office said.
“Prescription drug pricing is the No. 1 issue in the 7th District. ... It is what I hear about the most,” Spanberger said. “... I have tried to make it a priority.”