Saturday, 12 May 2018

6 Takeaways From Trump’s Plans to Try to Lower Drug Prices


President Trump has the facility to sink pharmaceutical stocks with one jab about high drug prices.

But during a much-anticipated speech on the subject on Friday, Mr. Trump largely avoided the problems the industry fears the foremost, like allowing Medicare to directly negotiate drug prices, or allowing Americans to import drugs.

Investors noticed: Stocks of major drug companies rose after his speech, as did those of pharmacy benefit managers or the “middlemen” that Mr. Trump said were getting “very, very rich.”

As the health care world parsed the president’s newly released “blueprint” to lower drug prices, the overarching insight appeared to be this: The drug industry’s formidable lobbyists had won some key victories, albeit they didn't escape entirely unscathed.

Many proposals were light on detail and can need action by Congress to become real.

Yet Mr. Trump won some praise for having taken a stab at tackling such a posh and the vitally important issue to several Americans.

Here maybe a rundown of the key proposals unveiled on Friday.

Lower drug prices for older people?

On the campaign trail, Mr. Trump embraced allowing Medicare to barter the worth of the drugs it buys for older people, a problem traditionally supported by Democrats but long opposed by Republicans — and therefore the powerful drug industry.

Friday’s proposal falls far in need of that goal. But it does include some ideas for giving the govt better leverage in negotiating with drug companies.

It involves exploring whether to permit Medicare drug plans to pay different amounts for an equivalent drug, counting on the illness involved.

And it might experiment with “value-based purchasing” in federal programs, essentially a money-back guarantee during which a drugmaker promises to refund money if a medicine doesn't work needless to say.

Drug companies and insurers are increasingly getting into these quite arrangements, although the evidence is way from clear that they lower costs.

The administration also reiterated earlier proposals: making generic drugs free for a few low-income older people on Medicare and allowing people to stay some of the rebates that are normally pocketed by the insurers that manage the Medicare drug program.

Persuade other countries to pay more

One key proposal would involve pressuring other countries to boost their prices for prescription medicines.

Drug prices within us are the very best within the world; many countries with centralized health care systems have successfully negotiated lower prices from pharmaceutical companies.

Mr. Trump, echoing the longstanding position of the drug industry, has said these companies are “free-riding” off the ingenuity of yank corporations, which high drug prices within us are subsidizing innovation that benefits the entire world.

“We have world power over the trading partners; you’re seeing that already,” Mr. Trump said on Friday.

“America won't be cheated anymore, and particularly won't be cheated by foreign countries.”

The Trump administration plans to figure with several federal agencies to deal with what is described as this “unfair disparity.”

But it's unclear whether other countries would be willing to boost their prices, or whether doing so would lead drug companies — which are beholden to shareholders hungry for profit — to lower prices within us.

Require drug ads to incorporate the price?

Prescription drug commercials are ubiquitous. But what if those ads had to disclose the drug’s price? that's something the Trump administration says it wants to explore.

The idea would definitely grab attention, and fear of a consumer backlash could pressure some drugmakers into dropping their prices.

But the notion poses tons of issues For one: which price?

The asking price, which is about what a pharmacy would charge if someone purchased the drug in cash?

Or the discounted price that insurers and employers pay?

Most consumers have insurance and pay away smaller out-of-pocket costs, although which will still add up to thousands of dollars a month.

Other questions include whether such a requirement would survive a primary Amendment the challenge, and whether posting a high sticker price — which few ultimately pay — could dissuade patients seeking out a necessary drug.

Finally, drug companies are masterful at distracting viewers from the lengthy list of risks and side effects that are already required by the Food and Drug Administration.

Some are known to use noisy brass sections or buzzing bees to de-emphasize the specified information.

Would the drug’s price similarly fade into the background?

Ban ‘gag clauses’ for pharmacists?

Some contracts between pharmacies and pharmacy benefit managers prohibit pharmacists from telling patients when a drug they have would be cheaper if they paid in cash, instead of using their insurance.

“This maybe a total rip-off, and that we are ending it,” Mr. Trump said in his speech on Friday.

The administration’s written proposal is vaguer, saying that it “may” prohibit these gag clauses in plans for Part D, the Medicare drug program.

End the patent games?

Patent protection for brand spanking new drugs is significant, the industry insists, to permit drug makers to recoup the many dollars invested in researching and developing life-saving products.

But over the years, the industry has become known for locating new ways to carry on thereto patent protection, and with it the facility to charge whatever it wants without generic competition.

One recent flashpoint has been the refusal of some brand-name companies to show over samples of their drugs to generic drugmakers, effectively preventing competing products from being developed.

Republican and Democratic lawmakers have proposed changes that might end this practice but are unsuccessful.

Trump said on Friday he would rein during this game-playing, saying “our legal system will reward innovation, but it'll not be used as a shield to guard unfair monopolies.”

On the horizon?

Some of the foremost theoretical ideas even have the potential to be the foremost disruptive.

One is to upend the prevailing rebate system, during which drug companies pay rebates, or discounts, off the asking price to insurers and employers.

But those rebates are often considered trade secrets and pharmacy-benefit managers pocket some of the rebates for themselves, creating what many have described as perverse incentives that keep drug prices rising.

The Trump administration has said it's examining whether it should consider rebates to be a sort of illegal kickback, a change that might likely require congressional action.

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