CMA applauds CDI and DMHC probe into Aetna’s practice of denying medically necessary care

September 30, 2019
Area(s) of Interest: Advocacy 

House Speaker Nancy Pelosi last week introduced a bill intended to lower the price of prescription drugs. The bill (HR 3) would allow the federal government to negotiate drug prices with pharmaceutical manufacturers to make a meaningful difference in controlling drug costs not just for seniors, but for all Americans. 

Under the current Medicare program, drug manufacturers set the prices, while all other Medicare providers (hospitals and physicians) are subject to a set government fee schedule.  The California Medical Association (CMA) supports Speaker Pelosi’s bill, and we have long-standing policy supporting legislation to authorize Medicare to negotiate drug prices.  

In 2016, total prescription drug spending reached $328.6 billion, more than double what was spent in 2002. One in four patients report that they or another family member did not fill a prescription in the last year because of cost.

Physicians are very concerned that patients cannot afford necessary medications that will improve their health and thus, many patients delay or forego their prescriptions altogether.

“Skyrocketing costs of prescription drugs are one of the main drivers of increased health care costs,” said CMA President David H. Aizuss, M.D. “Speaker Pelosi’s bill will allow Medicare to use its market power to negotiate fairer prices for patients’ medication and ensure that seniors, many of whom live on fixed incomes, will have access to the medicine they need.”

HR 3 would require the U.S. Health and Human Services secretary to negotiate the prices of the 250 most expensive drugs in Medicare and would impose a 65% penalty tax on annual gross sales for drug companies that refuse to engage in negotiations . The negotiated prices would be available to all purchasers, not just Medicare beneficiaries.

The bill would also cap seniors’ out-of-pocket prescription drug costs at $2,000 a year. And it would prohibit pharmaceutical companies from raising prices above the rate of inflation.


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