HENRICO CITIZEN, TOM LAPPAS

Seventh District U.S. Congresswoman Abigail Spanberger wrapped up a whirlwind two-day healthcare-inspired tour of her district with an hour-long discussion Nov. 26 at Glen Allen Library about Medicare, prescription drugs and changes involving both that she’s championing in Congress.

The topic of healthcare has been the top issue constituents have raised with Spanberger since she took office in January, she told the 60 or so people who gathered last week to hear her. Many of the attendees came with their own stories of healthcare confusion and prescription drug outrage.

One woman described her frustration that the therapeutic Botox she needs to take for the rest of her life (to address issues stemming from a stroke) is still patent-protected as a therapeutic drug but not so as a cosmetic treatment. That means that there is no cheaper generic version for her needs, but there is such a version for cosmetic usage. She spends $4,400 out of pocket annually, she told Spanberger.

Pharmaceutical patents are valid for 20 years after their creation, but it can take a decade or longer for the U.S. Food and Drug Administration to approve a drug for public use, which means that drug may only produce revenue for 10 years or so before much cheaper generic versions become available publicly.

But pharmaceutical companies can extend those patents through secondary patents, or “patent thickets” – small changes such as changing a drug from powder to pill form, or from a once-a-day dosage to twice-a-day, for example. Doing so allows them to lock out competitors – and keep the price of their drugs higher than it would be with competition.

In October, Spanberger introduced legislation that is designed to combat that issue as it relates specifically to biologic medicines – which treat diabetes, cancer and other diseases and are among the most costly drugs – by requiring pharmaceutical companies to publicly disclose their patents and by reducing the ways in which they may extend those patents.

Spanberger’s Biologic Patent Transparency Act, she believes, would foster generic competition from “biosimilars” much as the Hatch-Waxman Act of 1984 did for small-molecule drugs.

Bill seeks transparency

That bill is the second championed by Spanberger this year seeking more transparency in the world of prescription drugs; her Public Disclosure of Drug Discounts Act passed the House by a rare 403-0 margin. It would demand transparency about the process of rebates and discounts that prescription drug manufacturers provide to pharmacy benefit managers, or PBMs. Spanberger is hopeful that it will advance in the Senate, she said.

PBMs serve as intermediaries between drug companies, health insurance companies and pharmacies, typically establishing the way in which a health plan distributes its drugs and services (including whether there are “preferred” drugs and pharmacies) and establishing copay amounts.

PBMs wield significant power, because they determine which drugs insurance plans will and won’t cover. That allows them negotiating power with drug manufacturers, who often pay rebates or provide discounts to a PBM in exchange for the inclusion of their drugs in a PBM’s plans for its clients.

The negation process – including how many discounts and rebates are provided – is not public, but Spanberger’s bill would change that by requiring PBMs to post to a public website their price concessions for prescription drugs.

“By requiring that PBMs report their rebates, discounts, and price concessions, we are casting sunlight on a system that has significantly contributed to rising drug prices—and we’re giving patients, physicians, and employers the opportunity to understand how they are impacted by PBMs,” Spanberger said earlier this year.

That would be welcome news to a number of attendees of her meeting last week.

Drug costs vary wildly

One woman in the audience provided an illustration of her own experience with drug prices that fluctuate seemingly without reason, telling Spanberger that when her pharmacy ran out of the $5 blood pressure medicine she takes, it recommended another pharmacy – which was charging $275 for the same prescription.

“That certainly doesn’t help your blood pressure,” said AARP Virginia State Director Jim Dau (who joined Spanberger for the event), evoking laughter from the audience.

While noting that the example was similar to many others that she’s heard from constituents, Spanberger told the woman she was fortunate that she hadn’t been purchasing the drug from the second pharmacy all along, thinking that $275 was the cheapest rate available. And, she said, she was fortunate to live in an urban area with a variety of options for prescription drugs. Those who live in rural areas with limited options often end up paying higher prices, Spanberger said.

One particular diabetes medication is 13 times more expensive in the United States than in Canada, Spanberger said. Why?

The answer may be simple, Dau said: “In many cases, there are enough people paying what they’re asking for.”

More than a fifth of all prescriptions in Virginia are abandoned at the pharmacies that fill them, Spanberger said, because the patients realize they can’t afford them.

“In our prescription drug roundtable discussions, particularly with locally owned pharmacies, it’s driving them out of business, because they’re taking prescriptions that they can’t sell,” Spanberger said.

‘Nothing sustainable’ about increases

Dau emphasized the importance of efforts to address skyrocketing drug costs. The average price of brand-name prescription drugs rose 78 percent between 2012 and 2017, he said – but the average income increased by only 8 percent during the same period.

“There’s no keeping up with that,” he said. “There’s nothing sustainable about that.”

Citing his own wife’s successful battle with breast cancer – a fight she won thanks in part to the prescription drugs she received – Dau acknowledged that there’s a fine line between the rights of drug manufacturers to profit from the life-saving drugs they created and the needs of patients to be able to afford them.

“The treatment that she got saved more than her life,” he said of his wife, and the impact of her recovery on his family. “[Drug manufacturers] deserve it – but it’s got to be fair compensation.”

One of the most commonly cited examples of out-of-control drug costs is that of insulin, whose prices have tripled in recent years – up to as much as $16 a day for some people – even though it’s nearly 100 years old, Dau said.

The wild range in cost of prescription drugs struck one audience member as more than coincidental.

Although she pays hefty fees for certain drugs, “some of my medications are free,” she said. “They’re messing with us, I feel like. We’re being played big time.”

Another piece of legislation Spanberger is supporting (H.R. 3) would require drug manufacturers to negotiate prices of certain drugs with the Secretary of Health and Human Services for Medicare Part D – something that is not permitted currently. It would cap the cost of those drugs (including insulin) at 120 percent of the average price in several other countries.

The Congressional Budget Office (a nonpartisan group that analyzes and reports anticipated financial impacts of bills) estimated that the change would save the federal government $345 billion between 2023-2029 – money that it would no longer have to pay drug manufacturers.

Not surprisingly, those drug companies oppose the bill, arguing that it would cost them even more than that – $358 billion during the same timeframe – and subsequently result in as many as 56 fewer new medicines being developed during a 10-year period (the CBO suggested that number would be 8 to 15). The bill would particularly crush small biotech firms, according to a study conducted by economic consulting firm Vital Transformation for three biotech trade organizations.

The measure passed the House along mostly partisan lines, 230-192, last week but faces a less-certain future in the Senate.

From Spanberger’s perspective, the current situation is crushing many families beneath the weight of drug costs.

“These are challenges that impact peoples’ abilities to live and work and be a part of a larger community,” Spanberger said.