Democrats reveal pricing plan with 250-drug hit list
Targeted drugs are costing Medicare the most each year
A leaked draft of the Democrat’s long-awaited plan on medicine pricing in the US includes a list of 250 drugs that would be first in line for cost-cutting negotiations with Medicare.
The draft of the Drug Price Negotiation Bill from House Speaker Nancy Pelosi – which is still being tweaked and is reportedly due for an official unveiling later this week – also draws on President Trump’s plan to peg the cost of drugs to lower prices overseas, a proposal which is being fiercely resisted by drug industry lobbyists.
According to the document, the maximum price negotiated for the 250 drugs must be no more than 1.2 times the average price levied in six index countries – Australia, Canada, France, Germany, Japan and the UK.
The 250 medicines in the firing line are those which are costing Medicare the most every year, for example because they do not have at least two “generic, biosimilar or interchangeable” competitors in the marketplace.
It would also impose hefty penalties – equal to 75% of gross sales of a product in the prior year – on pharma manufacturers who do not reach an agreement or choose not to enter into negotiations.
The list is viewed by some as an attempt to find a middle way between Trump’s across-the-board reference pricing plan, and established Republican resistance to allowing Medicare to negotiate on price on the grounds that it runs counter to free-market principles.
That resistance means the bill could find it hard to get through the Republican majority Senate, but does have in its favour Trump’s eagerness to get legislation through that will fulfil his promises on medicine pricing as he campaigns for re-election next year.
House Speaker Nancy Pelosi takes aim at Trump
A summary document claims that in the first year alone “drugs representing almost half of all Medicare Part D spending…would be subject tot the negotiation process – including insulins”.
Insulin pricing has become a highly charged issue in the US amid reports of patients who are struggling to afford the injections rationing their doses, and putting themselves at risk of life-altering complications and even death.
Inflation rebate
Medicare Part D provides private health insurance to around 25 million people in the US. According to the draft, all the 8,000-plus drugs covered by that scheme as well as Medicare Part B – which covers drugs prescribed by a physician in a hospital or clinic – would be subject to a mandatory rebate if their prices increased above the rate of inflation since 2016.
That approach also echoes proposals by the Senate Finance Committee in July to limit price increases in Medicare to the rate of inflation, which has been backed by the Trump administration but is facing opposition from Republicans.
Industry body PhRMA said in a statement that the Democrat plan “would end the current market-based system that has made the US the global leader in developing innovative, life-saving treatments and cures”.
民主党期待已久的美国药品定价计划草案被泄露，其中包括一份 250 种药物的名单，这些药物将成为与联邦医疗保险 (Medicare) 进行削减成本谈判的首选。众议院议长 Nancy Pelosi 提出的药品价格谈判法案草案——该草案目前仍在调整中，据报道将于本周晚些时候正式公布——也借鉴了特朗普总统的计划，即通过固定药品成本来降低海外价格，这一提议正遭到制药行业游说者的强烈抵制。文件规定，250 种药品谈判的最高价格不得超过澳大利亚、加拿大、法国、德国、日本和英国 6 个指数国家平均价格的 1.2 倍。在发射线的 250 种药物是那些每年花费在医疗保险上最多的药物，例如，因为它们在市场上没有至少两个“仿制药、生物仿制药或可互换”的竞争者。对于没有达成协议或选择不参与谈判的制药商，还将处以相当于上一年度产品总销售额 75% 的重罚。该名单被一些人视为试图在特朗普的全面参考定价计划和共和党反对允许医疗保险以价格为由进行谈判之间找到一条中间道路，理由是它违背了自由市场原则。这种抵制意味着该法案将很难在共和党占多数的参议院获得通过，但特朗普迫切希望通过该法案，这将实现他在明年竞选连任时关于药品定价的承诺。众议院议长 Nancy Pelosi 的目标是特朗普，一份总结性文件声称，仅在第一年，“代表所有医疗保险 D 部分支出几乎一半的药物……将接受整个谈判过程——包括胰岛素”。在美国，胰岛素的定价已经成为一个备受指责的问题，因为有报道称，患者难以负担注射的配给剂量，并使自己面临改变生命的并发症甚至死亡的风险。D 部分为美国约 2500 万人提供私人医疗保险。根据草案，该计划涵盖的 8,000 余种药物以及医疗保险 B 部分（涵盖医院或诊所医生处方的药物），如果其价格自 2016 年以来上涨超过通货膨胀率，将受到强制退税。这种做法也呼应了参议院财政委员会在 7 月份提出的将医保价格上涨限制在通货膨胀率的提案，该提案得到特朗普政府的支持，但面临共和党人的反对。PhRMA 在一份声明中表示，民主党的这一计划“将结束目前以市场为基础的体制，这种体制使美国成为全球开发创新的、挽救生命的治疗和治愈手段的领导者”
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