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Drug-pricing proposals are the wrong way to reform health care

Drug-pricing proposals are the wrong way to reform health care

Here’s what good health care looks like: it emphasizes prevention, is accessible and affordable, and puts patients’ needs first.

Unfortunately, recently proposed health care reforms from Congress don’t look like that at all. Instead, they seem to be leaving patients behind. Lawmakers in Washington are turning to overly complex alterations of the market and restrictive models of care that do little to directly help patients now. To get a clearer picture, they need to start listening to patients.

They especially need to listen to those with chronic illnesses, who know all too well the damage that unexpected changes to treatment plans can cause.


Medicare remains the bedrock for quality health care treatment in the U.S. In California, where I live, roughly 4.5 million people rely on this program for care. While there are certainly areas in which Medicare can improve, beneficiaries give the program high marks for the access to care it provides. That’s what makes proposals to implement wholesale disruption to Medicare, potentially restricting access and undermining innovation, so troubling — especially when there are other reforms that more directly benefit patients without sacrificing Medicare’s strengths.

Take the proposal for international reference pricing. It would lower drug prices in the U.S. by linking them to the prices paid in 16 developed countries, including Germany, the United Kingdom, Canada, France, and Japan, and placing an arbitrary cap on U.S. drug prices. When you look at this proposal closely, it quickly falls apart. These countries, with vastly different health care systems, restrict patients’ access to medications or require them to try cheaper alternatives before being granted access to newer therapies.

That is unacceptable to people with chronic illnesses, many of whom live with multiple diagnoses and require treatment regimens tailored to their individual needs. If available treatments in Medicare become harder to access thanks to these foreign-based price caps, their health may suffer as a result.

The effect of drug pricing proposals in which the government sets prices will result in restricted access to medications for patients and doctors. Government price setting would have unaccountable bureaucrats dictate what treatments are available and which are not. As with international reference pricing, government price controls may create new, unnecessary barriers between patients and the quality care they have come to rely on within the Medicare program.

But we don’t have to choose between access and affordability. A simple way to control the cost of prescription medications, particularly for individuals living with chronic illnesses, is to place a cap on out-of-pocket spending in Medicare Part D. Doing so would directly alleviate individual cost burdens for medications without limiting options for treatment.

Medicare’s prescription drug benefit already includes ample negotiation between pharmaceutical companies, pharmacy benefit managers, and insurance plans. These negotiations produce substantial rebates or discounts for treatments. Unfortunately, many of these rebates never get to patients as they purchase medications, as intended. A beneficial and minimally disruptive approach to increase affordability for patients is to reform how these negotiated discounts get to patients. This simple change could go a long way toward reducing the costs of medications, without additional red tape or restrictions.

Understanding what good health care looks likes means we can recognize bad health care reforms when they are proposed. Patients calling for reform aren’t seeking more administrative red tape or arcane systems telling them which treatments are unavailable. They are simply calling for affordability to match the quality care they have received for years.

It’s time for lawmakers to start listening to patients.

Liz Helms is the president and CEO of the California Chronic Care Coalition.

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