Critics say Democratic presidential candidate Hillary Clinton's plan to address drug prices will just shift the costs from consumers onto insurers, who will increase premiums or refuse to cover more expensive specialty medications.
Clinton Tuesday unveiled a plan that includes placing a monthly cap of $250 on out-of-pocket spending on prescription medications, an approach that's been adopted by a growing number of states.
Clinton estimates up to a million Americans could benefit annually from the plan.
But some say such proposals don't get at the root of the problem.
“On one hand, capping out-of-pocket costs for consumers could help make medication more affordable over time,” Elizabeth Carpenter, a vice president at Avalere Health, said before commenting that plans might want to exclude some drugs from coverage.
In a statement on Tuesday, America's Health Insurance Plans CEO Marilyn Tavenner said setting price controls on plans would negatively impact costs.
"Consumers are looking to policymakers and leaders of both parties to advance meaningful solutions to these cost challenges,” Tavenner said. “We strongly believe that greater transparency around drug pricing and more competition in the market are critical to support sustainable, private-sector solutions that deliver the best value for patients and the health system.”
Tavenner added that AHIP is “committed to working with all policymakers to achieve those goals.”
As many as nine states have adopted similar strategies aimed at lowering out-of-pocket high drug costs within private health plans.
In March, California's insurance exchange became the first in the country to approve a monthly cap of $250 a month beginning in 2016. Another proposal would place price caps on drugs for all health plans in the state, not just those sold on the exchange, Covered California.
John Rother, CEO of the National Coalition on Health Care, said getting to the heart of the issue would require addressing the cost of drugs set by the manufacturer.
Clinton's plan looks to hit drugmakers in their pockets. She proposes an end to tax breaks for televised direct-to-consumer advertising, instead requiring drug companies that receive taxpayer dollars to invest in research and development.
The plan also would look to reduce the exclusivity period for biologic products from 12 years to seven, which her campaign stated would save an estimated $5 billion over 10 years and foster greater competition from generic or biosimilar versions of such drugs.
The proposal would also ban so-called “pay for delay” arrangements between brand-name manufacturers and generic-drug makers in which they are paid to delay launching generic versions onto the market.
Perhaps the most intriguing of Clinton's recommendations is to allow Medicare to negotiate drug prices, something a number of Democrats have supported for years.
The pharmaceutical industry has fought back, saying that approach would stifle development of new drugs.
“Secretary Clinton's proposal would turn back the clock on medical innovation and halt progress against the diseases that patients fear most,” said John Castellani, CEO of Pharmaceutical Research and Manufacturers of America, in a released statement on Tuesday. “These sweeping and far-reaching proposals would restrict patients' access to medicines, result in fewer new treatments for patients, cost countless jobs across the country and erode our nation's standing as the world leader in biomedical innovation.”
Joel White, president of the Council for Affordable Health Coverage, said Clinton's plan to impose Medicaid-style rebates on low-income Medicare seniors would increase premiums 20% to 40%. He said instead of cost caps, lawmakers should be looking at ways to keep people out of the hospital.
“Simply put, medication adherence is the right prescription for a healthy America, Clinton's plan is not," White said.
Still, polls show that drug prices are on the minds of Americans.
A survey conducted by the Kaiser Family Foundation in August found that 72% of Americans surveyed felt that drug prices were “unreasonable,” with 74% feeling as though drug companies put their profits before patients.
Earlier this week, Twitter became a battlefield after the CEO of Turing Pharmaceuticals defended raising the cost of Daraprim, the only known drug for the treatment of a parasitic infection called toxoplasmosis, from $13.50 to $750 a pill.
Speaking on “CBS This Morning,” Martin Shkreli responded that the drug was unprofitable at the previous price and that the company would use the money from sales to research more treatments.
