Tuesday, 20 November, 2018

The Trump administration takes on drug prices

Donald Trump speaking The administration is planning a Thursday speech to discuss drug pricing proposals
Anna Jefferson | 28 October, 2018, 22:24

The world reaps the benefits of American genius and innovation, while Americans pick up the tab, President Donald Trump said Thursday as he announced new measures to lower the drug prices in the country, which he said are higher in the United States and lower in other parts of the world.

The proposal-which follows more than a year of jawboning by Trump against rising prices of prescription medications-is projected to save Americans $17.2 billion over five years, the U.S. Department of Health and Human Services (HHS) said in announcing the International Pricing Index (IPI) payment model yesterday. Because the markup is a percentage of the average sales price, the system gives doctors an incentive to choose the most expensive drug available. "And especially, they would disrespect patents when it came to American-made drugs", Trump said. "In other words, Americans pay more so other countries can pay less".

"Finally seeing this system reformed, in fact, is one of the pharmaceutical industry's ultimate nightmares", said Health and Human Services Secretary Alex Azar, a former Eli Lilly executive, in a Friday speech.

In addition to trying to cut the base price of the drugs, the administration, through HHS, is proposing changing how doctors who deliver these drugs are paid.

The plan would establish a new "International Pricing Index" (IPI) payment model for certain expensive drugs covered by Part B, according to HHS.

The president is focusing on health care in the run-up to the midterm elections; Democrats have been hammering away at Republicans for their failed attempt last summer to repeal and replace the Affordable Care Act, a law Trump has fiercely criticized. It concludes the higher US prices means Medicare pays almost twice as much as the program would pay for the same or similar drugs in other countries.

"Over time this would cause major shifts in drug development and commercialization priorities - for example, manufacturers are likely to under-invest in office-administered injectables, and emphasize self injectable or oral products preferentially", wrote Leerink's Geoffrey Porges in an October 25 note. It will instead pay a set amount for storage and dispensing of Part B drugs, and it wants feedback from stakeholders regarding "how to make that work". "The administration is imposing price controls from countries with socialized health care systems that deny their citizens access and discourage innovation", PhRMA President Stephen Ubl wrote.

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An HHS report issued just prior to Thursday's announcement compared prices of 27 Part B drugs in the us with those of 16 other wealthy countries and found that prices charged by drugmakers to wholesalers and distributors (known as "ex-manufacturer prices") in the USA were 1.8 times the average global ex-manufacturer price, in the first quarter of 2018. "It's unfair and it's ridiculous, and it's not going to happen any longer", Trump said during a May 15 speech on drug pricing. The United States is the biggest funder of research and development in the pharmaceutical sector, yet now lacks the bargaining power to bring prices down - unlike in countries with public health-care programs. "President Trump asked us to fix this problem and here's how we plan to do it". Those drugs that stand to lose the most revenue include Rituxan from Genentech and Biogen, Amgen's Neulasta, Regeneron's Eylea and Genentech's Lucentis. "There was only a single case in which the USA was paying lower than the global average".

Already, however, there is skepticism about how much this will impact the drug industry. "This is very much about putting America first".

The 19-page report looks specifically at drugs purchased and dispensed by doctors themselves under Medicare's Part B program.

Another concern: The federal government's negotiating power is more limited when it comes to Part B drugs because Medicare can not exclude medications.

The administration has moved twice this month to lower drug prices in other ways. In a March Kaiser Family Foundation poll, eight in 10 respondents said drug costs are unreasonable and 92 percent said passing legislation to bring down the cost of prescription drugs should be a top or important priority.

Trump has promised sweeping action to attack drug prices, both as president and when he was running for the White House. "It really changes business as usual for a lot of institutions that make money off of high prices of drugs".

While Trump did not specifically name the drug, he was presumably referring to Roche's biologic Lucentis (ranibizumab) by comparing the numbers he cited with figures in the HHS report released earlier Thursday.

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