Lawmakers seek balance between lower prescription drug prices, drug innovation incentives

Leading health legislators say they are focused on reducing prescription drug prices while minimizing unintended consequences of the Inflation Reduction Act (IRA).

House Rep. Scott Peters, D-California, and Rep. Mariannette Miller-Meeks, R-Iowa, shared their priorities during a program put on by The Hill and the Alliance for Aging Research.

Peters stressed that the drug manufacturing industry needs to stay in the U.S., unlike how the country let chip manufacturing business slip away and go offshore. He also wants lawmakers to budget healthcare expenditures differently.

“Innovation might cost more money upfront, even if it saves money down the line,” he said. “In the Budget Committee, which I also serve on, we're talking about how to think about balancing the budget over time. If we don't think about the future costs of all these diseases, as part of that calculation, I think we're going to miss the mark.”

More from Fierce Pharma

As Medicare price negotiations roll on, drugmakers counter HHS' initial offers

While healthcare expenditures continue to soar, and the IRA will do well in limiting cost of drugs for patients, Peters acknowledged there are issues needing a revisit.

“We're only finding that there's some … distortions in the incentives we created that we could correct,” he said, noting that investment in biologics have increased, yet investment in small molecules in the neurology field has decreased to nearly zero.

There is little incentive for manufacturers to invest in existing drugs for new diseases, he added. Still, these setbacks are “pretty minor in the context of what we’ve achieved,” he added.

Miller-Meeks believes balancing innovation with lower drug prices comes from reforming pharmacy benefit managers—a bipartisan, but stagnant, topic in Congress. One bill she supports would ban spread pricing and save the government more than $600 million, though she never supported the drug price negotiation program due to its effects on innovation.

“It has already had a dampening effect,” she said.

Republicans have maintained the IRA’s drug price negotiation program will hinder and disincentivize innovation of drug development. Democrats say the legislation accomplishes its goal of lowering prescription drug prices.

Medicare enrollees no longer pay more than $35 a month for insulin, and, starting in 2025, there is a $2,000 out-of-pocket cap, with any cost below $2,000 subject to three, no-interest payment installments. The Medicare prescription payment plan is an opt-in benefit.

“While patients may see a lot of benefits at the counter today, long-term access to treatment will be hindered,” worried Dana Goldman, Ph.D., professor of public policy, pharmacy and economics for the University of Southern Carolina, on a panel following the lawmakers’ remarks.

Another unintended consequence of the IRA is that more financial risk has shifted to health insurers, leading to more instances of prior authorization and step therapy, said Michael Ward, vice president of public affairs and government relations for the Alliance for Aging Research.

On the Affordable Care Act (ACA), Miller-Meeks declared strongly she personally is “not going to try to repeal the ACA" but suggested that opinion may not extend to the rest of her party.

“We also know I have no influence within my conference because I’ve taken on my leadership on maybe one too many of occasions, which is why I had a robust primary,” she said.

“I wish the Republicans would declare they’re going to repeal Obamacare again,” Peters quipped. “That was pretty good for us.”