The sky-high costs of prescription drugs is a monumental issue in our nation that needs to
be addressed and reformed. As a nation, we pay the highest prices for prescription drugs
compared to the rest of the world, which has caused an uproar amongst our citizens. Research
shows that in the past year, approximately “one in five Americans between the ages of nineteen
and sixty-four –64 million people, did not get their prescriptions refilled because they did not
have enough money” (On The Issues, 2018). As healthcare consumers in the wealthiest nation, it
is unacceptable that people are going without their necessary medications due to an inability to
afford them. Though there have been efforts made towards policies reforming drug prices in the
United States, the current state of this dilemma shows that immediate action must be taken, and
policies need to be reformed to either lower drug prices or offer alternatives to consumers.
According to a report from the National Academies of Science, Engineering, and
Medicine, there are policy reforms that can be implemented to fix this issue such as
“consolidating the government’s purchasing power to negotiate lower drug prices with
manufactures, closing loopholes in the regulatory framework that block competition, and
mandating pharmaceutical price transparency” (Kacik 2017). There are people who have been
paying tremendously high prices for their medication for years, and still don’t have the option for
a generic version of the drug due to monopoly pricing and blocks of generic drugs. A recent
uproar occurred over this issue following the death of 26-year-old Alec Smith. Smith suffered
from type-1 diabetes and was under his parents’ insurance plan until his 26 th birthday in June of
2017. After getting kicked off his parents’ plan, the burden of purchasing his insulin fell on
Smith alone. Less than a month later, Alec Smith lost his life due to a lack of insulin because he
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was budgeting his medication until his next paycheck. This case hit home for millions of
Americans across the nation who have found themselves in similar situations. Another
nationwide problem that has been causing chaos in the lives of thousands of Americans is the
opioid crisis. According to the New York Times, in 2017, President Trump declared the opioid
crisis a “health emergency,” following over 59,000 deaths by overdose in 2016 (Davis, 2017).
Though the issue I am discussing differs from the opioid issue, they relate in a certain way that is
supported by an article titled “The Opioid Epidemic: Who Is to Blame?” There have been
several reported cases of patients who were prescribed pain medications that they were unable to
afford, so they resorted to self-medicating with street bought drugs. This is not to be taken as a
generalized statement that the pharmaceutical industry is to blame for every addict’s substance
abuse, but it does indeed support the dire need for policy reform.
There are two major types of public policies: regulatory and distributive policies. A
regulatory policy is when the “government prescribes and controls the behavior of a particular
group, by monitoring the group and imposing sanctions if it fails to comply.” The types of policy
reform I am seeking for this issue would fall under regulatory policies, with the pharmaceutical
industry being the “particular group” whose actions the government should prescribe and
control. The reason that drug pricing reform policies should be regulatory policies, is because the
focus is not to reallocate funds from one entity to another, but to impose effective regulations
upon the entity in control, which in this case, is the pharmaceutical industry.
There are far too many loopholes being used by this industry to keep the prices of
prescription drugs as high as they are. According to an article titled “Big Pharma Vs. The
People,” consumers are upset because “they feel that the drug companies abuse the laws, abuse
the system, and take advantage of people” (Lo, 2018). The Food and Drug Administration (FDA)
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Commissioner Dr Scott. Gottlieb has condemned the practices of the pharmaceutical industry
such as “drug-makers blocking access to reference samples for generic competitors” (Lo, 2018).
President Donald Trump himself has emphasized drug price reform as one of the core issues of
his administration, and once stated that pharmaceutical companies are “getting away with
murder” (Lo, 2018). We can all agree that there is an incredibly visible nationwide issue here,
and the next step is creating solid policies that will be effective without providing loopholes for
drug-makers to continue manipulating through. As stated in an article on WebMD - Canada, like
most other industrialized nations “imposes restrictions and limit what pharmacies can charge for
drugs” (Osterweil, 2018). These restrictions are the reason for the fact that the same brand-name
medication can cost up to 55% more in the United States than in Canada. I am proposing a drug
pricing policy reform that will impose similar restrictions by state on the pharmaceutical industry
in the United States as well.
Addressing the Issue
I feel that my policy solution would best be suited at the state level. Though I would love
to see nationwide restrictions on the pharmaceutical industry, I believe that it is best to address
this issue by state, then with positive results, hopefully the federal government will follow. The
policy solution I am proposing for the state of Virginia is a modified version of a bill that was
proposed to mandate drug pricing transparency. In the fiscal year 2015, Virginia’s total spending
on prescription drugs exceeded $1.2 billion (rga.lis.virginia.gov). Moreover, the continuous rise
of drug costs “drives increases in Medicare and private insurance premiums, including those on
the Exchange, thereby negatively impacting Virginia consumers” (rga.lis.virginia.gov). The
recently proposed bill in Virginia would have “required drug makers to provide detailed financial
information which would include costs for R&D, manufacturing and marketing, price changes,
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profits, and financial assistance for consumers” (Policy and Medicine, 2018). The
pharmaceutical industry fought back saying that “it unfairly singled out the pharmaceutical
industry,” and that “the cost to develop a particular drug has little to do with that drug’s price.”
The Virginia General Assembly Senate panel voted to delay consideration of the proposed bill,
making Virginia one of many states whose efforts towards drug transparency legislation had
fallen short of successful. In my modified version of this bill, I want to focus less on the
transparency concerning the prices of production for the drugs, and more on setting a regulated
limit how much payers are required to pay for the drugs. This idea was derived from the Health
Service Cost Review Commission (HSCRC), which is an independent state agency in Maryland.
The HSCRC doesn’t focus on regulating what hospitals charge, rather it imposes a limit “on
what payers will pay regardless of what the hospital charges.” Not only would this method of
regulation help reduce the burden of costs for consumers, it could potentially lead to the
pharmaceutical industry lowering the price of the drugs because of a strict cap on what they can
sell them for.
In order to successfully propose a bill that has any chance of it becoming a law, a strong
execution plan is necessary. First and foremost, one must determine who can be deemed as
strong allies to tackle the issue with and gain the attention of policy makers in the government.
For my particular case, The Virginia Center for Health Innovation (VCHI) is an organization that
I would like to work towards this mission with. The VCHI is a community of healthcare systems,
providers, employers, consumers, and pharmaceutical manufactures that came together in 2010
to engage in health reform. Getting this organization on board with my proposed policy would be
incredibly beneficial, because it is composed of members from various backgrounds and
standpoints of the situation. This is an organization that has healthcare providers and consumers
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on the team, as well as pharmaceutical manufacturers. This gives us the advantage of being able
to have the opinions of people from both sides of the issue come together and work towards
reaching a goal that benefits the greater good.
Another organization I would want to work towards this mission with is a non-profit
generic drug company that has been launched and is set to be operational by 2019. Intermountain
Healthcare is a non-profit health system that is based in Salt Lake City, Utah that “aims to make
generic versions of critical drugs that are in short supply and are prohibitively expensive in the
United States (Trager, 2018). Though this organization is based in another state and is taking a
different approach to the issue of drug pricing in the nation, I believe that presenting their
mission to policymakers will further emphasize for the need of changes and regulations on this
issue. The fact that individuals are taking matters into their own hands to develop non-profit
organizations that will ease the burden of prescription drugs to the public should speak volumes
to policymakers.
It would also be beneficial to have renowned physicians from Virginia advocating
alongside my team to push for this policy solution. Healthcare providers have firsthand insight
into the world of pharmaceuticals and the struggle that thousands of patients have with affording
them, so it would be an advantage for me to have physicians on board with my proposal. I am
currently employed at a medical office as a front desk secretary and I receive multiple calls from
patients everyday asking if there are other options to the medication that they were prescribed
because they cannot afford it. I find it noteworthy to share that I work in the very affluent town
of Ashburn, Virginia, yet every single day patients are opting out of medications or looking for
alternatives due to an inability to afford it.
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Networking is essential when dealing with a task of this nature, so it is crucial to gain the
support of as many people as you can. I would reach out to the hosts of local television and radio
stations and share my concerns with them. As regular working people, I am confident that we
will find support in many people who can relate to the issue at hand and would be passionate
about helping. Having the support of influential people with a large base of listeners is a key
component when you are ready to start lobbying.
Once we have gathered all the support we can get, we will start calling our
representatives for support to win over their vote. The National Academy for State Health Policy
Report, The Secretary of Health and Human Services, The Department of Medical Assistance
Services, and The Virginia Department of Health are all agencies that will be targeted during my
lobbying efforts. The National Academy for State Heath Policy actually provides a model for
states to draft a proposal to promote prescription drug price transparency and cost control. This is
an agency that would be incredibly supportive of our initiative, so efforts will be made to gain
their attention during this process. Living in the Washington, D.C. area is very convenient for
lobbying purposes. If I cannot get a direct hold of my representative or senators, I would make
an appointment with a staff person. I would come well-informed, equipped, and prepared to
answer any questions that may arise. Following my in-person attempt, I would send a thank-you
note and use it as an opportunity to reiterate my argument. It is also important to publicize these
efforts, so I would try to get booked on local radio shows, write letters to the editors of local
papers, and hold local events or workshops that will cover the issues I am addressing and how.
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Proposed Policy
Committee: Drug Price Reform Principal Author: Ruth Yosef
Delegation: House of Representatives
Bill No: Modification of HB 1436 Prescription Drug; Price Transparency
A BILL ENTITLED
1. An ACT concerning
Imposing a Limit on How Much the Pharmaceutical Industry Can Charge
Consumers for Prescription Drugs to Tackle Issue of High-Cost Drug Prices
2. BE IT ENACTED BY THE CONGRESS HERE ASSEMBELED THAT:
3. SECTION 1. We are proposing that a state regulated limit be imposed on the
4. pharmaceutical industry to put a cap on the amount that they can charge consumers
5. for prescription drugs
6. We are proposing this bill to help decrease the monumentally high spending cost
7. that we have accumulated from high-drug prices
8. We also seek to lighten the burden on consumers who require these life-saving
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9. medications, but are unable to afford the market prices for these brand-name drugs
10. SECTION 2. To clarify any ambiguity from section one – by “putting a cap” on the
11. amount that the pharmaceutical industry can charge consumers for prescription
12. drugs, a state regulated policy would protect citizens from sky-high, monopolized
13. drug prices.
14. SECTION 3. The State’s Department of Health will oversee the enforcement of this
15. bill along with these specific enforcement mechanisms:
16. The executives of pharmaceutical companies will be asked to sit with the committee and
17. provide a detailed overview of their products and the current price on the market
18. The committee will review the pharmaceutical industries justifications of their prices
19. and determine a reasonable limit to impose on how much said company may charge
20. for life-saving medications
21. Once an agreement has been made on a regulated limit for drug-costs, consumers will no
22. longer be charged anything above the set limit.
23. When a new drug is manufactured, the company must provide a detailed overview of the
24. drug, the proposed market price for the drug and a justification for the price
25. the manufactures of the drug must submit these details to a committee for review
26. Through this enactment of this bill, we hope to continue to move forward toward
27. drug-pricing reform
28. SECTION 4. This act shall take effect on January 1 st , 2019.
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References:
Fighting to Lower Prescription Drug Prices
https://berniesanders.com/issues/fighting-to-lower-prescription-drug-prices/
Kacik, A (2017). Policy reforms needed to lower drug prices. Retrieved from
https://www.modernhealthcare.com/article/20171130/NEWS/171139991
National Academy for State Health Policy
https://nashp.org/wp-content/uploads/2017/03/Transparency-Model-Legislation1.pdf
Lo, C (2018). The People Vs. Big Pharma
https://www.pharmaceutical-technology.com/features/people-vs-big-pharma-tackling-
industrys-trust-issues/
Trager, K (2018). Intermountain Healthcare
https://intermountainhealthcare.org/about/
Pharmaceutical regulation
http://ushealthpolicygateway.com/vii-key-policy-issues-regulation-and-reform/l-health-
care-regulation/pharmaceutical-regulation/#Pharmaceutical_Prices-2
Virginia the latest state to push drug pricing transparency bill
https://www.statnews.com/pharmalot/2016/02/02/virginia-drug-prices-transparency-bill/