Soaring prescription medication costs have placed significant burdens on many people and prompted calls for comprehensive reform. Congress has acted, seeking to enact legislation to rein in drug prices.
This battle has long been fought by lawmakers, pharmaceutical companies, health providers, and patients. As the issues dominate public discourse related to the U.S. healthcare system, public pressure has forced Congress to usher in a new era of drug pricing laws that aim to prioritize affordability, transparency, and access.
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On Aug. 16, 2022, President Joe Biden signed into law the Inflation Reduction Act. The law, one of the Biden administration’s signature domestic achievements, included a broad package of health provisions, including several that aim to lower the prescription drug costs for people with Medicare and to reduce drug spending by the federal government.
The Inflation Reduction Act provides Medicare with the ability to negotiate prices for outpatient (Part D) and physician-administered (Part B) drugs. On Jan. 11, the Centers for Medicare and Medicaid Services announced a time frame for implementation of the Inflation Reduction Act's drug pricing provisions. The time frame also indicates that the availability of these drugs will increase each year. But the implementation will prove difficult due to staffing concerns at CMS.
The Department of Health and Human Services on June 9 subsequently announced a list of 43 prescription drugs for which coinsurances may be lower for Medicare beneficiaries between July 1 and Sept. 30, 2023. Depending on their coverage, some Medicare recipients taking these drugs may save between $1 and $149 per average dose starting July 1, according to the department.
The passage of the Inflation Reduction Act is considered a victory for congressional Democrats, but Congress seems to still have an appetite for reform. Now, Democrats have introduced subsequent legislation that would allow CMS to negotiate drug prices sooner than when the Inflation Reduction Act specified.
Sens. Amy Klobuchar (D-MN), Peter Welch (D-VT), and 23 others have introduced the Strengthening Medicare and Reducing Taxpayer, or SMART, Prices Act, legislation aimed at further lowering prescription drug costs for consumers. The bill builds on provisions included in the Inflation Reduction Act, granting HHS enhanced authority to negotiate for Medicare Part D. It also would increase the number of eligible drugs and accelerates the time frame for negotiation. Currently, the standard is 13 years.
But critics insist that the measure would double down on existing price control mechanisms of the Inflation Reduction Act, calling it a “slippery slope” of increased government involvement in healthcare that would significantly limit patient access to lifesaving treatments. Instead, critics suggest lawmakers review the “real drivers” of high cost: insurers and pharmacy benefit managers. They believe tackling these aspects of the healthcare system would be a more effective approach to reducing prices and ensuring affordable access to medications.
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The debate surrounding the SMART Prices Act places crucial responsibility on lawmakers to thoroughly evaluate the potential outcomes of this legislation. Their challenge now lies in striking a balance between the goals of lowering drug costs and ensuring patient access while also addressing concerns regarding increased government intervention and potential implications for receiving innovative treatments.
This dialogue and careful consideration will shape the future of drug pricing reform in the United States as lawmakers navigate the complex landscape of affordable and accessible healthcare for all.