This week, the Biden Administration released the first ten medicines that will be subject to price negotiation. These negotiations are possible thanks to the key components in the Inflation Reduction Act (IRA) that was passed last year. While it’s easy to think that this will save money, the hard fact is that it probably will not save patients money at all and will actually hurt the drugs that are in development. That is why when the drug list was announced, we saw headlines like “A Tragic Day For American Patients” and “Today is Not A Day To Celebrate”
The healthcare system in this country surely has its issues. At the same time, having worked with patients from 72 countries, we can say that there is no better country for healthcare anywhere. Anyone who has had a surprise medical bill, has been denied coverage, or had sticker shock at the pharmacy counter can certainly testify about the financial toxicity of healthcare. Instead of picking on one industry, the Administration would be wise to sit down with insurance companies, hospital systems, and pharmacy benefit managers (PBMs) to tackle healthcare costs in a way that puts a patient’s well-being first and profits secondary. But with the release of these ten medicines that will be “negotiated”, it’s obvious that the powers-that-be are picking on the very industry that provides the groundbreaking cures upon which patients rely.
The basic truth is that research and development is important if we are to see advancements. That is true in everything from aerospace to alternative energy to drug development. The Biden Administration has made the “Cancer Moonshot” program a major building block in their health care policy, but with the Inflation Reduction Act, they’ve essentially blown it up on the launchpad. To reach their goal of saving four million lives in the next 25 years, there needs to be innovation and breakthroughs in the way we treat cancer, but there needs to be funding and revenues available to get there. One of the drugs on the list to be negotiated is an innovative blood cancer medicine. That particular drug (ibrutinib/IMBRUVICA) has transformed patient care in CLL, chronic lymphocytic leukemia, and has also been approved in Waldenström macroglobulinemia (WM) extending the lives of many blood cancer patients. Would ibrutinib have reached and remained in the market if there weren’t the significant investment and resources poured into its clinical development over nearly two decades? I think we know the answer.
That is why we cannot look at this policy and think that it’s a realistic solution to lowering drug prices. So what is the solution? Let’s start with the pharmacy benefit manager industry. PBMs are just middlemen who use every trick in the book to increase profits and leave patients out in the cold. That is why Congress has an array of bills out there to tackle the PBM industry. While none has passed yet, the fact that they are out there shows that our leaders are quickly realizing that it is the most realistic way we could see lower drug prices and lower out-of-pocket costs. The Inflation Reduction Act does not help patients. It simply shifts the money away from research, development, and innovative new technologies in treating diseases like cancer, Alzheimer’s, and Parkinson’s disease. If the IRA–and in particular its small molecule penalty, which jeopardizes ongoing research and development going forward–is not rolled back or fixed, then the next wave of life-extending cancer therapeutics is in serious jeopardy. Those transformative and ever-more tolerable oral drugs simply won’t be developed.
Senators Kyrsten Sinema and Mark Kelly have the opportunity to put the patient voice in their policies. Now that the serious problems of the Inflation Reduction Act are coming into focus, I hope they will turn their attention to fixing the legislation so that we aren’t asking ourselves in twenty years “Where did all the cures go?”
