My credit card hovered over the card reader at the pharmacy as I contemplated whether I should pay. Two hundred and eighty dollars and some change. For two EpiPens, each with 0.3 mg of epinephrine that could potentially save my life if I accidentally ate something with sesame seeds. At that moment, I realized that even I, as someone with good employer-based family health insurance, was being forced to make a judgment call in regard to buying an expensive medication. After a few seconds, I decided not to pay. I resolved that I could just use my old, expired EpiPens if the situation demanded. No need to waste money.
Unfortunately, this is the tough reality for tens of millions of Americans who, just like me, are forced to make difficult decisions when it comes to paying for prescription medications. And it’s no secret that prescription drug prices are higher than ever and still increasing. The United States on average pays 250% more for prescription drugs than other OECD countries, and this statistic increases to 344% for some brand-name drugs. Because of this, approximately 25% of Americans state that they find it difficult to afford prescriptions due to high out-of-pocket costs. Data also shows that almost 8% of Americans do not take their medications to save money and 10% skip doses in an attempt to ration. The cost increase in the EpiPen, an epinephrine auto-injector produced by Mylan, is a textbook example of the explosive increase in prices of life-saving treatments in the U.S. Since 2007, its average wholesale price has skyrocketed from $94 to over $700.
While not much had been done in the past to reduce egregious prescription drug prices, the United States finally started fighting back with the now-dead Build Back Better Act (BBBA), a mammoth $2 trillion bill addressing issues such as climate change, housing, and healthcare. Before it died, the BBBA would have given Medicare the ability to negotiate prescription drug prices with manufacturers for the first time in history, starting with negotiating the prices of 10 drugs in 2025, and then ten more by 2028. Because Medicare has immense bargaining power due to its 62 million beneficiaries, manufacturers would have been compelled to agree to lower prices in order to compete in this market. This is analogous to the practice in countries like the U.K., where the National Health Service negotiates drug prices with the pharmaceutical industry on behalf of the entire country’s population under the Pharmaceutical Price Regulation Scheme (PPRS) every five years. This policy explains why average prescription drug prices in the U.K. are 3.6 times cheaper than in the U.S., and why new bills like the BBBA are so critical to pass.
In addition to negotiation privileges, the most recent draft of the BBBA stated that Medicare would only have to pay 75% of the price that commercial U.S. insurers pay for certain prescription drugs. The BBBA also required drug manufacturers to pay rebates to Medicare if certain prescription drug prices increase faster than the national inflation rate. Finally, another provision included a $2,000 cap on how much Medicare patients must pay for prescription drugs per year.
While there was a glimmer of hope when the BBBA was passed in the House in November of 2021, all momentum has been completely squashed since by Senator Joe Manchin, who has retracted all support of the bill and has called it “dead” this February. Manchin’s main concern regarding the BBBA is how expensive it is – at over $2 trillion, it would add a substantial amount to America’s staggering $30 trillion debt.
However, the American people saw somewhat of a revival of the prescription drug pricing war on March 1st during Biden’s State of the Union Address. Biden spoke of drug companies that upcharge insulin by 30 times its production cost, which is $10 per vial. He also stated to “let Medicare negotiate lower prices for prescription drugs.” With these statements, Biden is clearly attempting to rebuild momentum to resuscitate this specific part of the BBBA.
Although the Herculean effort of the BBBA was abandoned, Congress should quickly follow the president’s lead and revive prescription drug pricing reform in a more targeted bill. A majority of Americans want solutions to lower unreasonable drug prices, and addressing it carries bipartisan support. Tackling this problem could help tens of millions of Americans who are forced to choose between drug prescriptions and financial ruin.
Hassaan Asif is a medical student.
Image credit: Shutterstock.com
