Guest Author
Health care works best when we protect the physician-patient relationship to ensure the patient has access to the right medication or treatment at the most appropriate time — and can afford that medication or treatment. Congress continues to review prescription drug prices, and unfortunately, the Senate Budget Reconciliation Bill is another attempt that fails to address patient access and affordability.
When reviewing this issue, we must address all parts of the system and evaluate the role of the biopharmaceutical manufacturers, health insurers, and pharmacy benefit managers. Without evaluating the system, the bill fails to summon the tools necessary to lower out-of-pocket health care costs for consumers.
I have had the opportunity to advocate for health care policy in the oncology space for decades, and this bill raises questions about how it will affect, and fail to support, Florida’s cancer patients.
Many of the policies included in the Senate Budget Reconciliation Bill are not new, but rather failed policies we’ve seen proposed time and time again. For example, while government price controls and “negotiation” may sound like a good idea, we’ve seen how this would negatively impact medical innovation and access in other countries.
America’s innovation ecosystem allows drug manufacturers to produce some of the highest quality research and development successes in the world: Americans have access to 90% of new treatments and cures, compared to just 50% of patients in countries with price controls measures like France and Canada.
Cancer is one of many diseases without a cure. New cancer research is constantly being developed with the objective of creating a cure, and of increasing the quality of life for cancer patients. Provisions of the bill that stifle innovation will be most harmful to patients battling fatal diseases, when these are the patients that most need our support.
For more than 15 years, Medicare Part D has provided the vast majority of seniors and people with disabilities affordable and comprehensive medicine coverage. This bill attempts to weaken the Part D redesign and fails to make meaningful changes to an insurance system that needs improvement to ensure all beneficiaries can afford their medications. The bill attempts to increase cost sharing for seniors from 23% to 25%, and it pushes back implementation of a $2,000 out-of-pocket cap until 2025. This is troubling for the 60% of cancer patients aged 65 and older who will see no significant change in their treatment affordability.
There are solutions to ensure patients have access to innovative and affordable medications and treatments. Congress should ensure the rebates and discounts that drug manufacturers pay to health insurers and pharmacy benefit managers are passed on to patients for out-of-pocket costs — instead of pocketed for profit.
This simple fix would considerably reduce the cost of medicines. In fact, pharmacy benefit managers are currently under investigation by the U.S. Federal Trade Commission for this very practice, as well as their influence over drug prices for patients. Gov. Ron DeSantis recently signed an Executive Order “directing our state agencies to look at all their contracts with PBMs and ensure that costs to the state of Florida are justified.”
Florida’s Congressional Delegation must look toward policies that continue to protect and preserve the physician-patient relationship by ensuring access to innovative, affordable treatment and future cures. Policies like renewing a clean version of the Prescription Drug User Fee Act will propel innovation forward while holistically addressing Medicare Part D to guarantee access to affordable, innovative care for our seniors in Florida.
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Michelle Flowers is the founder of the Oncology Managers of Florida, an organization dedicated to information, education, and advocacy for oncology practice managers throughout the state.
