by Leslie Small
As is the case for other flavors of health care reform,
President-elect Joe Biden's chance of passing substantial, transformative
drug-pricing legislation is now highly dependent upon whether Democrats can eke
out a majority in the Senate. While that question won't be resolved until
Georgia completes runoff elections in January, industry observers point out
that there are still ways that a Biden administration can address drug pricing.
"A president can do a lot even with a divided
Congress," says Stephanie Kennan, a member of McGuireWoods Consulting's
federal public affairs group. "Part of how well something gets
done…depends upon the skills of the president or those negotiating for him.
With Biden perhaps having a better understanding of the Senate, having come
from the Senate, [that] might help him."
During a webinar held on Nov. 5, Avalere Health experts
highlighted restructuring the Medicare Part D benefit as an area of potential
bipartisan compromise. "I see something like that packaged with the health
care extenders that'll need to move in 2021," said Chris Sloan, an
associate principal at the consulting firm.
Yet Kathryn Bakich, the National Health Compliance Practice
Leader at Segal, says that adding an out-of-pocket cost cap in Part D could
raise some concerns from employers. "The problem with that is for
employer-sponsored plans that have a Part D program, that could make the value
of that program less to them," she says.
In a Nov. 3 note to investors, Leerink SVB analyst Geoffrey
Porges pointed out that using regulatory authority to rein in drug prices won’t
have as large of an impact as legislation would. "Drug pricing mechanisms
implemented via executive order are likely to be limited to a small class of
higher-priced drugs within Medicare and Medicaid, with expansion to the
commercial side requiring congressional action," he wrote.
Porges also argued that regardless of who is in charge of the
federal government, "the PBM system is likely to remain a target of future
reforms."
Going forward, it's likely that "lawmakers will focus on
the incentives governing formulary decisions and rebates in considering drug
pricing reform, although the vehicle for this change is highly uncertain,"
he wrote.
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