Senate Judiciary Committee Debates Causes of US Drug Prices

On May 7, the Republican-led Senate Judiciary Committee reviewed an “International Pricing Index Model” developed by the administrative branch to bring the cost of provider-administered medications down to “align more closely with prices in other countries,” according to Modern Healthcare. The model has been created for Medicare Part B, a small subset of pharmaceutical purchases, and may be tested in some randomly selected regions of the US.

The Committee’s discussion got tense when it turned to the Transparent Drug Pricing Act previously introduced by Sens. Rick Scott’s (R-FL) and Josh Hawley (R-MO) last month that would impose an international drug price index on the commercial insurance market. This triggered vigorous discussion of legislative proposals for lowering drug prices.

A “Conscience Clause” from DHHS

On May 2, the Department of Health and Human Services (DHHS) issued a final rule allowing health care workers to refuse to deliver specific medical services “on account of religious beliefs or moral convictions.” This has been introduced in other administrations and by the current administration in January 2018, under the auspices of the Office of Civil Rights. That proposal was rapidly shelved due to public backlash. The Academy’s statement on the issue, released on January 19, 2018, is available here.

In the new rule issued last week, abortion, sterilization, and assisted suicide procedures are all labeled as assignments that health care workers may refuse to undertake. While not specified in the rule, other acts that health care providers may refuse on the basis of conscience may include treating people for gender dysphoria, providing naloxone to prevent opioid overdose, or the administration of Medication Assistance Treatment (MAT) drugs to treat substance use disorders.

According to DHHS, this 440-page rule “ensures that healthcare entities and professionals won’t be bullied out of the health care field because they decline to participate in actions that violate their conscience, including the taking of human life.” It defines a “health care entity” as “an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.”

Some states already allow pharmacists, on the basis of conscience, to refuse to provide any form of contraception (including emergency contraception for rape survivors). They can also withhold information if asked about where emergency contraception can be obtained. For more information, see Health Affairs here.

San Francisco city Attorney Dennis Herrera has already filed a request to delay implementation of the new rule to allow further judicial review. He argues that, as written, it will “reduce access to critical health care.”