American Society of Hematology

Access to Care and Drug Pricing: An Update for 2019

A lot has happened since the 116th Congress was sworn in in early January, or at least since the government shutdown ended January 25, 2019.  The shutdown, which began on December 22, 2018, was the longest government shutdown in history.


When it comes to healthcare, two big issues stand out as priorities for the 116th Congress. The first, access to care, including protecting and improving the Affordable Care Act (ACA) and launching a new version of Medicare for All legislation, is one that remains important to Democrats in Congress, who saw it as the number one issue for voters in last year’s midterms. The second, lowering the cost of prescription drugs, is at the top of the list for the Trump Administration, and the 116th Congress has not shied away from the issue. This topic, which is certainly not new for the American people, is an area likely to see bipartisan support.      


Access to Care


Democrats are now in control of the U.S. House of Representatives and are working to reverse many of the policies enacted by the Trump Administration to rollback key components of the ACA.  Legislation has already been introduced to reverse the administration's expansion of short-term plans that do not need to comply with the ACA's protections for pre-existing conditions; to restore ACA outreach and enrollment funding that has been slashed; and to funnel $200 million to states to set up their own ACA marketplaces. That is not an exhaustive list, but just a handful of the proposals introduced to protect the ACA. It’s unlikely these bills will make it through a Republican-controlled Senate, but Democrats are taking the opportunity to make their positions public.


Meanwhile, a group of over 100 House Democrats introduced a new version of Medicare for All legislation, the most detailed blueprint yet for how they would overhaul the healthcare system. Last year, 124 Democrats signed onto a different version of the legislation. With the Democrats still divided on the issue and a Republican-led Senate and Administration, it is unlikely the bill will see much movement this year.  


Lowering the Cost of Prescription Drugs


The Administration released a number of policies, both proposed and final, in 2018, aimed at lowering the cost of prescription drugs. For a refresher on what happened in 2018, click here.


Already, the 116th Congress has followed suit, introducing multiple bills to tackle the high cost of drugs. Ideas include getting generic drugs on the market faster, capping out-of-pocket costs, importing drugs from Canada, and allowing for more robust Medicare negotiations for drugs. At the end of March, the House Energy and Commerce health subcommittee approved six drug pricing bills, including two bills which would provide generic and biosimilar makers more information through U.S. Food and Drug Administration (FDA) databases about the patents on branded products. Both the House and Senate still need to vote on these pieces of legislation.

  In late February, the Senate called seven pharmaceutical executives to testify before the Finance Committee. While all of the executives agreed that the status quo cannot remain, they were quick to place blame elsewhere, on insurers, government, and pharmacy benefit managers (PBMs).  Senator Grassley, Chair of the Committee, announced that pharmacy benefit managers would be next to testify, with a hearing scheduled for April 9.  

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