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October is Breast Cancer awareness month (Photo: Flickr)

Congress Must Protect Medical Innovation that Benefits Cancer Patients

Prescription price-setting policies being enforced through Medicare is a misguided policy that could undermine critical medical and drug advancements

By Kim Yaeger, October 18, 2023 4:07 pm

The day I was diagnosed with breast cancer – two years ago – is one that I will never forget. Anyone who has heard their doctor say those three words, “You have cancer,” understands what a life-changing experience it is. Today, I am lucky enough to call myself a survivor, having undergone a single mastectomy last year. This National Breast Cancer Awareness Month, I am grateful to the medical innovation and advancements that have allowed me to be where I am today.

However, while I’m cancer-free for now, there is always a lingering concern that it could come back. Moreover, as both a mother and grandmother, I now live with a nagging fear that they too could be susceptible to this devastating disease. That is why I am such an avid supporter of increased research into the causes of cancers and the development of new therapies, treatments, and, hopefully one day, cures that benefit patients.

It is for that reason that our elected officials in Washington must avoid misguided policies that could undermine critical advancements in medicine and the drug development process. Prescription price-setting policies being enforced through Medicare is a perfect example.

While on the surface it may seem like prescription price setting could be a solution to help reduce costs for patients at the pharmacy, in reality the impact of these policies could have a negative impact on patients. First, prescription price-setting policies can make it harder for patients to access certain medications and treatments available today. Even more troubling, however, is the fact that prescription price controls could restrict the resources scientists need to continue discovering, developing, and bringing to market new, innovative treatments that could help save countless lives.

If Congress is serious about wanting to help reduce costs and improve access for patients, then our lawmakers should avoid more prescription price-setting policies and focus on reforming insurers and their pharmacy benefit managers (PBMs). With control of roughly 80% of the prescriptions available today, PBMs can essentially dictate when and where patients can access the critical medications they need, often erecting new barriers to care where there should be none.

Through restrictive policies like pharmacy “steering,” where a patient is forced to use a certain pharmacy and pay a higher price, or “step therapy”, where PBMs requires that a patient try one or more cheaper drugs before “stepping up” to the more expensive drug prescribed by their clinician, PBMs create unnecessary delays that prevent patients from getting the care they need, when they need it—all in the name of boosting profits. Even more reprehensible is the fact that these healthcare middlemen will actually secure rebates on prescription drugs directly from manufacturers, only to pocket the savings instead of passing them down to patients to help reduce burdensome out-of-pocket expenses.

Lawmakers in Washington have been discussing the harmful impact PBMs have over patient access for the past year. However, despite multiple committee hearings in the House and Senate as well as different, bipartisan solutions being introduced, there has yet to be any mention of a floor vote on PBM reform legislation in either chamber of Congress.

For the good of cancer patients—and patients struggling with an array of diseases —that has to change. Congress should work overtime to pass PBM reform like the Delinking Revenue from Unfair Gouging (DRUG) Act before the end of the year. This legislation would help bring greater accountability over PBMs and transparency into practices they use that threaten patient access to life saving medications.

For National Breast Cancer Awareness Month, Congress should honor cancer patients and survivors by passing legislation to reform PBMs in order to help ease the burden of high prescription costs and help make life-saving drugs and treatments more accessible and available to all who need them.

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Kim Yaeger
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