Attacking Rising Prescription Drug Costs

Published in the Woonsocket Call on April 7, 2019

The Washington, DC-based AARP timed the release of its latest Rx Price Watch report as the House Energy Commerce Committee marked up and passed a dozen bills just days ago, six that would lower prescription drug costs. The legislative proposals now go to the House floor for consideration.

AARP’s new report, a continuation of a series that has been tracking price changes for widely used prescription drugs since 2004, was circulated to House Committee members before their markup and vote and its findings sent a message to the lawmakers that they hear from their older constituents, that is the costs of pharmaceutical drugs is skyrocketing, making it difficult to fill needed prescriptions.

Poll after poll findings reflect the concerns of seniors about their ability to pay for prescribed medications. According to a Kaiser Family Foundation poll released last month, 79 percent of survey respondents view drug prices to be “unreasonable,” while just 17 percent found the costs to be “reasonable.” Twenty-four percent of these respondents found it difficult to pay the costs of their prescription drugs.

Generic Drugs Can Save Dollars

According to the new AARP Public Policy Institute (PPI) report, by Leigh Purvis and Dr. Stephen W. Schondelmeyer, the average annual cost of therapy for one widely used brand-name prescription drug in 2017 was over 18 times higher than the cost of therapy for one generic drug. The cost for a generic medication used on a chronic basis averaged $365 per year. In contrast, the average annual cost for a brand-name prescription drug was $6,798. But, four years earlier the price differential between these same market baskets was substantially smaller ($4,308 verses $751 respectively).

“Generics account for nearly nine out of every 10 prescriptions filled in the U.S. but represent less than a quarter of the country’s drug spending,” said Debra Whitman, Executive Vice President and Chief Public Policy Officer at AARP, in a statement released with the PPI’s 28 page report “These results highlight the importance of eliminating anticompetitive behavior by brand-name drug companies so that we get more lower-priced generic drugs on the market,” says Whitman.

AARP’s PPI report, entitled “Trends in Retail Prices of Generic Prescription Drugs Widely Used by Older Americans,” found that retail prices for 390 generic prescription drugs commonly used by older adults, including Medicare beneficiaries, decreased by an average of 9.3 percent in 2017, compared to the general inflation rate of 2.1 percent. The decline follows two consecutive years of substantial generic drug price decreases; the previous two consecutive years saw increases in generic drug prices. All but three of the 390 generic prescription drugs analyzed in AARP’s report had a retail price change in 2017. While prices for 297 (76 percent) drug products decreased, 90 (23 percent) products had price increases.
Six commonly used generic drug products had retail price increases of greater than 70 percent, including a nearly 200 percent increase for sertraline HCL, an antidepressant, finds the AARP.

AARP’s PPI report found that with older adults taking an average of 4.5 prescription drugs every month, those using generic prescription drugs were likely to have an average annual retail cost of $1,642 in 2017.

“The gap between average annual brand-name and generic drug prices has increased dramatically—brand name drug prices were six times higher than generic drug prices in 2013 but more than 18 times higher in 2017,” said Leigh Purvis, Director of Health Services Research, AARP Policy Institute, and co-author of the report. “As long as brand name drug prices continue to skyrocket, the value of prohibiting brand name drug company practices that slow or prevent competition from generic and biosimilar drugs cannot be overstated.”

AARP Pushes for Passage of Bills to Lower Drug Costs

Before the Committee on Energy and Commerce vote on April 3, in correspondence AARP urged Chairman Frank Pallone, Jr. (D-N.J.) and Ranking Member Greg Walden (R-Ore) to enact two bills (along with four other proposals) being considered at the morning markup session. These legislative proposals would lower prescription drug costs and had previously been approved by the Energy and Commerce Health Subcommittee.

In the correspondence, AARP’s Nancy A. LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer, pushed for passage of H.R., 1499. the “Protecting Consumer Access to Generic Drugs Act of 2019.” introduced by Rep. Bobby Rush (D-IL). This proposal would make it illegal for brand-name and generic drug manufacturers to enter into agreements in which the brand-name drug manufacturer pays the generic manufacturer to keep a generic equivalent off the market. The bill was passed by voice vote.

LeaMond also supported H.R., 965, the “Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019,” introduced by Reps. David Cicilline (D-RI), Jim Sensenbrenner (R-WI), Jerrold Nadler (D-NY), Doug Collins (R-GA), Peter Welch (D-VT), and David McKinley (R-WV). The proposal would establish a process by which generic manufacturers could obtain sufficient quantities of brand drug samples for testing thereby deterring gaming of safety protocols that brand manufacturers use to delay or impede generic entry. The bill passed by a bipartisan vote of 51-0.

At the markup, Pallone and Walden were able to work out philosophical differences on H.R. 1499 and H.R. 965. The two lawmakers also hammered out a compromise on H.R. 1503, the “Organize Book Transparency Act of 2019,” that would ensure that the Orange book, which identifies drug products approved on the basis of safety and effectiveness by the Food and Drug Administration, is accurate and up-to-date.

Washington Insiders say that Democratic control of the House will ensure the passage of these legislative proposals on the House floor and the bipartisan vote on the CREATES Act in the lower chamber creates an opportunity for Senate Finance Committee Chairman Chuck Grassley (R-Iowa) to successfully push his CREATES Act companion measure in the Senate.

Grassley says the broad, bipartisan action by the House Energy and Commerce Committee to advance the CREATES Act is a major win for consumers. “I look forward to advancing this bill because it will cut down on abuses in the system that keep prices high for patients. I’m also pleased that the committee advanced a bill to address pay-for-delay schemes. Although that bill is not identical to the bill I’ve sponsored in the Senate, the bill’s movement shows that the committee is serious about addressing the pay-for-delay problem,” says the Senator.

As They See It…

AARP’s LeaMond, says “Brand-name drug companies want to stifle generic competition to protect their monopolies and profits. AARP believes that eliminating these deliberate anticompetitive behaviors will result in a more robust generic drug market and greater savings for both patients and taxpayers. The Congressional Budget Office estimated that legislation such as the CREATES Act could save taxpayers more than $3 billion over a decade, and the Federal Trade Commission estimated pay-for-delay deals cost consumers and taxpayers $3.5 billion a year.

“We have long supported the CREATES Act and banning pay-for-delay agreements, and are heartened that Congress is acting to improve access to generic drugs. These bills will promote competition driving down costs for seniors,” says Lisa Swirsky, Senior Policy Analyst, at the National Committee to Preserve Social Security and Medicare.

“Congressman Cicilline has been a leader in our caucus for putting prescription drug prices at the front of our agenda. Moving generics to market faster is an important step to lower prescription drug costs for every American,” said House Speaker Nancy Pelosi. “House Democrats have made it a top priority to lower Americans’ health costs by reducing the price of prescription drugs, and these bipartisan bills show we mean to deliver,” she says.

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AARP Report Says Older Americans Value Livable Communities

Published n Pawtucket Times, May 16, 2014

If they had their druthers, the vast majority of people age 50 and older plan to remain living independently right at home in their communities “aging in place”, concludes a new report released last month by the AARP Public Policy Institute. The 43 page report which surveyed boomers and seniors found that both value secure neighborhoods, safety, good schools, safe streets for walking, access to transportation, parks and affordable housing as community amenities. With these resources in place, communities enhance personal independence and foster resident engagement in civic, economic and social life, qualities that AARP has traditionally used to describe the livability of a community.

“What older Americans and Millennials want in terms of their community is not all that different.” said AARP Executive Vice President for Policy, Debra Whitman. “What is livable differs for each of us, whether we want a warm climate or a dense city, for example,” she said. “But this report tells us that the fundamental elements of a community that will please America’s aging population will equally serve future generations [as well].”

Maintaining Independence in the Community

The new report, “What is Livable? Community Preferences of Older Adults,” unveiled April 25, 2014, is based on focus groups and a survey of more than 4,500 participants. These findings reaffirm the historic trend that most people ages 50 and older want to age in place. Adults ages 65 and older are even more likely (87 percent) to say they want to age in their current home or community than those ages 50 to 64 (71 percent).

A small portion of adults age 50 and older – about one in six – say they plan to move in the next three years. This thought is more common for members of minority groups, those with low-incomes, those who don’t drive, or those living in metropolitan areas, notes the report.

According to the AARP report, many factors play into the hierarchy of a person’s community preferences. Specifically, household income influences the importance of local government spending priorities on local schools, transportation, personal safety, and proximity to various amenities. Race and ethnicity also play a role as do health and one’s life stage. African-American and Latino respondents ranked affordable housing more highly than respondents in general, for example, while caregivers and people with disabilities rate the availability of specialized transportation more highly than those who are not in those categories.

Participants were also asked, “What community amenities do you want close to home?” Access to public transportation, food and green space topped the list, the researchers say.

Effectively Planning for Livable Communities

Jeff C. Davis, Principal Planner at the Rhode Island Division of Planning, notes that AARP’s report mirrors his state agency’s views as what is a livable community. State planners’ strategy is to identify and promote areas where Rhode Island should grow – places in the state that already have a core of residential and commercial development or are well suited to planned, future development; they are the places that will accommodate and nurture Rhode Island’s future growth while protecting its natural and cultural resources.

According to Davis, livable communities can be found in downtown places like Providence, Westerly, Newport and Warren and in villages like Wickford, Harrisville, Wakefield and Pawtuxet. “These places offer a mix of homes, shops, community services, jobs, and public open space, connected not just by roads, but bus routes, bike paths, and in some cases trains,” states Davis, stressing that the Ocean State is also “very fortunate that a lot of these places have beautiful architecture and access to water, whether rivers, ponds, or the ocean.”

Davis believes that zoning ordinances through the state make it difficult to recreate livable places, or to enhance existing centers with sensitive development. “Many of our older urban communities have the bones of a livable, walk able place, but need targeted reinvestment to come alive again with a mix of uses and housing,” he says.

“The state and our cities and towns need to continue to work together to make sure local zoning allows and encourages center development, finds ways to prioritize funding and other supports for these areas, and makes sure that we are planning physically and financially for inclusive and accessible places,” adds Davis.

Davis is seeking public input to make Rhode Island’s communities more livable. “We are currently working on a planning campaign called RhodeMap RI, and need feedback on ideas for growing Rhode Island’s economy and providing for healthy homes and great communities.”

“It’s All in Our Backyard”

“The one surprise in the AARP report is that health care was not a major concern,” says President and CEO Neil Steinberg, of the Rhode Island Foundation, the state’s largest and most comprehensive funder of nonprofit organizations. “We hear about it all the time. In fact, access to quality, affordable health care is one of our strategic priorities,” he says.

“Almost everyone probably can agree on what makes a livable community. They have vibrant arts and culture, concern for children and families, economic opportunity for all, a great educational system, a sound environment, quality health care, housing that doesn’t break the bank and programs that meet basic human needs,” states Steinberg..

“The fact that we do have livable communities is what keeps Rhode Islanders here generation after generation,” says Steinberg, noting that the state’s small size gives its residents a “statewide feeling of connectedness.”

“This sense of belonging may be the most important factor in defining a livable community,” adds Steinberg.

The Rhode Island Foundation which awarded more than $ 31 million in grants last year to help nonprofits tackle critical issues in the state, has implemented a very visible public awareness campaign that reminds people that the Ocean State is a special, very livable place, notes Steinberg. “It’s All in Our Backyard” is about pride of place. It is an effort to help Rhode Islanders connect with our state’s rich resources, he says.

“There are plenty of success stories right here,” Steinberg says, noting that Rhode Island has “global industry and cutting-edge innovation, thriving entrepreneurship and world-class universities, breathtaking landscapes and a major arts scene.”

Steinberg urges, “Let’s celebrate Rhode Island as the vibrant, stimulating place where we work and live.”

It’s a Mixed Bag

AARP Rhode Island State Director Kathleen S. Connell observes that neighborhoods widely differ in the state’s 39 towns and cities, and within larger cities. “That said, a fair assessment would be that there are examples of great strides toward more livable communities as well as places in Rhode Island that are in a state of neglect.”

“The good news is that where improvements are being made today the process is much different when it was a decade ago as far as taking into consideration the interests of a broader range of stakeholders,” Connell adds.

Connell says that “many of the state’s older neighborhoods qualify as “livable” insofar as they are blessed with open space, sidewalks, are near parks and bike paths and feature transportation infrastructure that is designed with consideration for all types of users and people of all abilities.” Many planners and members of zoning boards understand the concept of livable communities and work hard to maintain and expand livable features,” she notes.

“But as the AARP survey revealed, livable also [also] means good schools, responsive local government, safety, convenient public transportation and affordable housing,” adds Connell, noting that there are still “parts of the state where these things have yet to come together that can be improved and communities made more livable.”

Connell warns that making a community livable should not be just to benefit the older population. “It’s really about people of all ages who want to live comfortable, healthy and environmentally responsible lives,” she says, detailing examples that include more public, park-like space in a retail/business district. These are assets for Rhode Islanders of all ages.

“A greener environment can enhance the business climate and local economy and works for all citizens on that level, too,” states Connell. Bike paths benefit all age groups and curb cuts benefit young moms with baby strollers as much as they are helpful to folks who get around with the aide of walkers,” she says.

The AARP study’s findings show that both young and old gravitate to livable communities. These localities allow persons to be more active, stay fit, even connected, allowing aging boomers and seniors to live independently at home. Rhode Islander’s might just think about The Rhode Island Foundation’s message, “It’s All in Our Backyard.” While we have a little ways to go to be a completely livable state, we’re closer to that goal than some naysayers believe.
The full report “What is Livable? Community Preferences of Older Adults” can be found at http://www.aarp.org/research/ppi/liv-com2/policy/Other/articles/what-is-livable-AARP-ppi-liv-com.

For more information about the Rhode Island Foundation’s “It’s All in Our Backyard,” go to http://www.ourbackyardri.com.

For details about RhodeMap RI, and to take the State’s surveys on housing and economic development, go to http://www.rhodemapri.org/rhodemap-virtual-open-house.

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.