President Trump’s Unveiling of the “American Patients First” Plan

A vivid indicator of the impact of President Trump’s May 11 speech on drug pricing was that pharmaceutical stock shares spiked as soon as the speech was over. The pharmaceutical industry clearly found it reassuring.

One in four Americans have difficulty paying for their prescribed medications. The President campaigned on a pledge to use the massive buying power of the US government to pressure pharmaceutical manufacturers to reduce their prices for Medicare drugs. But his long-awaited “American Patients First”, plan unveiled on May 11, does not reflect that commitment. According to CNN, experts say that the plan as “mainly tinkers around the edges of the problem”, adding that “few expect the president to try to regulate what manufacturers charge for their drugs.”

In his Rose Garden speech, the President declared emphatically that “We are very much eliminating the middlemen.” But American Patients First, itself, is not a blueprint for such action. With 57 million Americans on Medicare, the government has substantial leverage to negotiate with drug manufacturers for price discounts. Instead, the Trump plan leaves those negotiations up to the insurers who sell private Medicare Advantage Plans. Since only one third of people on Medicare enroll in such plans, the prices faced the majority who are traditional Medicaid recipients do not benefit from these negotiations. This breaks the campaign promise. In the words of the New York Times, “he dropped the popular and populist proposals of his presidential campaign, opting not to have the federal government directly negotiate lower drug prices for Medicare.”

American Patients First outlines vague steps, with unclear timelines, through which various entities including insurers, Pharmacy Benefits Coordinators and others may take action to help address the problem of people being unable to afford their medications. One strategy it mentions is that pharmacists can disclose to their patients that they may – with some drugs – save by paying out of pocket price rather than the Medicare Part D price. The President’s speech, as Axios noted, “focused in rearranging costs rather than lowering them.”

CNN quoted Gerard Anderson, a health policy expert at Johns Hopkins University who said of the plan, “is not doing anything to fundamentally change the drug supply chain or the drug pricing system.”

Lifetime Limits on Access to Medicaid Rejected by CMS

On May 15, Seema Verma, Administrator of the federal Centers for Medicare and Medicaid Services, announced that CMS would not approve state proposals to set lifetime limits on Medicaid eligibility. Kansas applied earlier this month for a waiver to limit lifetime Medicaid access to three years after which, The Hill reported, “people would lose access to Medicaid forever”. Maine, Arizona, Utah and Wisconsin have also applied to set lifetime limits but Verma’s announcement indicates that these will be denied and that there is a limit to the administration’s flexibility with regard to Medicaid access.

AAHIVM Joins HIV/AIDS Community to Call for Investigation of How Insurers Treat Drug Coupons

A coalition of 60 HIV/AIDS advocacy groups, including AAHIVM, is calling on state attorneys general and insurance commissioners to investigate changes in how insurers treat co-pay coupons for expensive drugs. Many insurers have stopped counting the drugmaker discounts toward deductibles and out-of-pocket spending limits. That means patients could end up with big, unexpected bills for crucial drugs once they’ve used up the coupons.

“This practice is particularly concerning when applied to medications for which there is no generic alternative, which is the case for the vast majority of drugs used to treat and prevent HIV,” reads a letter sent to insurance regulators and attorneys general in all 50 states from the coalition. “In those cases, failing to count co-pay assistance cards toward a consumer’s deductible and out-of-pocket maximum leaves the consumer with no affordable coverage option.” Read the letter here.


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