January 16, 2018
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Prescription drug savings could reduce federal budget cuts

By Ann Woloson, executive director of Prescription Policy Choices

I’m not going to pretend I thought the congressional supercommittee would come to agreement on how to slash $1.2 trillion from the federal budget. With members of the committee drawing lines in the sand from the beginning over ideological differences in taxes and spending (half had previously signed a pledge not to raise taxes), it was clear that King Sisyphus has company.

I continue to be optimistic, however, given there are clear examples of savings which could be achieved, without raising revenues or forcing draconian cuts to programs we all depend on, including Medicare and Social Security.

One obvious example is our nation’s continued obsession with unnecessary spending on health care services, including prescription drugs. Estimates show a third of our health care spending is unnecessary. Eliminating such waste could help to trim our budget, while at the same time ensure better quality and value in our public health programs.

A straightforward example of such unnecessary spending includes the unwarranted use of brand-name prescription drugs when cost-saving generics or therapeutic alternatives are available. While it’s true that nearly 70 percent of prescriptions are filled with generics, there’s still plenty of room to increase the use of these safe, effective and cheaper drugs.

It’s been reported, for example, that as Lipitor becomes available in generic form this week, pharmacy benefit managers, or PBMs, are instructing pharmacies to continue filling prescriptions with the more expensive brand-name drug. Lipitor’s manufacturer has apparently agreed to provide significant discounts to PBMs successful in blocking the use of the generic, which means consumers and payers will continue to pay a lot more for a drug when an effective and cheaper alternative is available.

Consumers approaching the doughnut hole under Medicare Part D are being steered toward more expensive drugs with the lure of 50 percent discounts on brand-name drugs, while discounts of up to only 7 percent to 14 percent on generics are being phased-in over time. To the extent that such discounts distract the elderly from choosing a safe, effective and lower-priced generic over a newer brand-name drug, consumers and payers will continue to pay more.

A study released last week revealed foster children are being prescribed anti-psychotic drugs at higher levels, comparable to disabled children. The relevance of the study is significant, given the jump in spending on such drugs by our public health programs over the last decade. It’s even more significant given there is little scientific evidence demonstrating the effectiveness of such drugs with young children, especially when weighed against likely health consequences including weight gain, diabetes and high blood pressure.

Policy makers could surely agree on a policy that would preserve access to these drugs while at the same time prevent overuse in vulnerable populations. Some states have instituted such policies. There has been no public outcry from patients, families or physicians, and the prescribing of the drugs to children in those states has dropped significantly.

These are examples of issues our policy makers could start working together on to preserve access and achieve savings. Though we all want the best treatment available, we often mistakenly believe the more expensive drugs are more effective. Ultimately, we all want the best available medicine at the best price. Most of us also want to avoid the risk of adverse effects from a drug we might not need in the first place.

As Congress grapples with the budget, they should leave Sisyphus with his rock and focus on obvious places most can agree on to achieve savings. The finger-pointing about who’s at fault for not coming up with an impossible solution is just making the rock fall harder, and the potential for progress even more elusive.

Ann Woloson is executive director of Prescription Policy Choices, a nonprofit, nonpartisan organization with the goal of improving access to effective, safe and affordable prescription drugs in Maine and the U.S. She lives in Belgrade Lakes.

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