Legislation Grid and Testimony/Advocacy Statement

Introduction

Advocacy is a major pillar of nursing. In their workplaces and communities, nurses
instinctively advocate for their patients. Even though it is less commonly practiced by nurses,
political and legislative advocacy is equally important in advancing patient care. Understanding
the legislative process that transforms proposals into laws is key to having effective legislative
advocacy. This paper examines the making of Medicare Prescription Drug Savings and Choice
Act of 2019, a bill that seeks to reduce the cost of prescription medication for persons enrolled in
Medicare. It will examine its goals, the legislative steps it has undergone, and various arguments
that support its passage.

Part 1: Legislation Grid

Health-related Bill
Name

Medicare Prescription Drug Savings and Choice Act of 2019.

Bill Number H.R 4769.
Description

The Medicare Prescription Drug Savings and Choice Act of 2019 seeks
to lower the cost of medications for Americans. The main requirement of
the bill is that the Centers for Medicare & Medicaid Services (CMS)
establishes at least one prescription drug plan that Medicare operates.
The prescription drug plan must serve the whole of the United States.
Additionally, it should be the default plan for all people who enroll
under the Medicare prescription drug benefit, unless they choose another
plan. The bill also requires CMS to negotiate prices for prescription
drugs that are covered under the plan. If appropriate, the CMS is to
encourage the use of therapeutic equivalents that are more affordable.

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Currently, CMS cannot negotiate prices of drugs that are covered under
the Medicare prescription drug benefit. Under the bill, the Agency for
Healthcare Research and Quality will provide CMS with the information
that it needs in order to effectively conduct price negotiations (Medicare
Prescription Drug Savings and Choice Act, 2019).

Federal or State? Federal

The bill was introduced in the House of Representatives by Rep. Janice
Schakowsky (D-IL-9).

Legislative Intent The intention of the bill is to lower the cost of drugs for persons with
disabilities and seniors who are enrolled in Medicare Part D through
increasing competition for plans and empowering Medicare to negotiate
for cheaper drug prices on behalf of its beneficiaries (Medicare
Prescription Drug Savings and Choice Act, 2019).

Proponents/
Opponents

Proponents: The proponents of the bill are mainly members of the
democratic party and those who stand to benefit from the bill, such as
persons with disabilities and elderly citizens who are enrolled in
Medicare.
Opponents: The opponents are large drug companies because any
lowering of drug prices is going to have a negative impact on their
profitability. Thanks to their ability to determine the prices of various
drugs, the drug companies have managed to make large profits through
arbitrarily increasing essential prescription drugs.

Target Population The bill targets persons who are enrolled in the Medicare Part D

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prescription drug program. They are primarily senior citizens and
persons with disabilities.

Status of the bill
(Is it in hearings or
committees?)

The bill was introduced in the House of Representatives on 21st
October, 2019. On the same day it was referred to the Committee on
Energy and Commerce as well as Committee on Ways and Means. On
22nd October, 2022, it was referred to the Subcommittee on Health of
the Committee on Energy and Commerce (Medicare Prescription Drug
Savings and Choice Act, 2019). Currently, the bill is still at the
Subcommittee on Health level. Subcommittees consider proposed bills
in greater detail (Milstead & Short, 2019). It is at this stage that various
affected parties are heard and amendments to the bill made (Milstead &
Short, 2019).

General
Notes/Comments

The bill seeks to lower the costs of medications for senior citizens and
persons with disabilities. Since they are among the heaviest consumers
of healthcare services and medications, the bill has the potential of
providing them with significant financial relief. If passed in its current
form, the bill will go a long way in weakening the powers of big drug
companies. At the moment, their price gouging has made the cost of
medications beyond reach for many people, especially vulnerable groups
like the elderly who really need the medications. The empowering of
Medicare to negotiate on behalf of their beneficiaries will also give
consumers powers that they have hitherto lacked.

Part 2: Testimony/Advocacy Statement

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The per capita expenditure on prescription drugs in the United States is by far the
highest in the world. According to Kesselheim, Avorn & Sarpatwari (2016), the per
capita spending on prescription drugs in the U.S. is $858. The figure is more than double
the average per capita expenditure of other industrialized nations (Kesselheim, Avorn &
Sarpatwari, 2016). Due to the high cost of drugs, it is estimated that 17% of overall
personal healthcare services is now comprised of prescription medications (Kesselheim,
Avorn & Sarpatwari, 2016). The high cost of drugs acts a barrier to healthcare access as
many people have to do without the required medications because of their cost.

It was estimated in 2019 that 58 million Americas were unable to pay for their
prescription medications (Schakowsky, 2020). Around 34 million knew either a family
member or friend who had died in the previous five years because they could not pay for
their treatment drugs (Schakowsky, 2020). The situation is especially bad for elderly
citizens who are heavy consumers of healthcare services. The high cost of drugs has a
major negative effect on their health. Each year, thousands of senior citizens die
prematurely because of inability to afford medications. It is estimated that by 2030 over
112,000 senior citizens will die prematurely due to inability to afford prescription drugs
(Schakowsky, 2020). Thus, the high cost of prescription drugs in the U.S. has become a
major killer of many Americans.

Various factors have been cited for increasing drug costs. The most important of
these factors is market exclusivity (Kesselheim, Avorn & Sarpatwari, 2016). Unlike other
industrialized countries where where governments are involved in pricing of drugs, the
U.S. allows drug companies to set their own prices (Kang et al., 2020). Through Food

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and Drug Administration’s approval and the use of patents, many drug companies in the
U.S. enjoy protected monopoly (Kesselheim, Avorn & Sarpatwari, 2016). Having
monopoly power allows the drug companies to price the drugs as they want. The drug
prices only start coming down once the period of market exclusivity elapses. The only
ways of forcing drug companies to reduce their prices during the period of market
exclusivity is through increasing the power of the payer and encouraging competition
from other drug manufacturers from other countries.

The Medicare Prescription Drug Savings and Choice Act of 2019, in its current
form, helps to achieve both objectives. First, it increases the power of the payer by giving
Medicare the power to negotiate with drug companies for affordable drug prices.
Individual consumers of prescription medications have too little power to effectively
negotiate with the large drug companies. However, Medicare, representing millions of its
beneficiaries, has the power to effectively negotiate with the drug companies and help in
bringing down drug prices. Currently, Medicare does not have such powers and,
therefore, drug companies deal with payers that have very little, if any, bargaining power.
Secondly, the bill allows Medicare to administer its own prescription drug plans which
will compete with privately administered prescription drug plans that are very expensive.
Such competition is likely to significantly reduce the cost of prescription drugs.

When addressing opponents of the bill, I will cite the great positive effects that
the bill is likely to have on senior citizens and persons with disabilities. The reduction in
cost of prescription drugs will lead to savings of billions of dollars by the targeted
population. More importantly, the reduction will save the lives of thousands of seniors

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who die each year because of their inability to afford to prescription drugs. There is no
doubt that the use of legislation is the most effective way of achieving reduction in drug
prices. Other avenues of reducing drug prices, such as executive order have been
explored in the past. For instance, President Trump has tried using executive order to
force drug companies to reduce drug prices. This strategy has not worked because
executive orders are generally ineffective as policy instruments. Thus, the use of
legislation to effect drop in drug prices is likely to achieve the desired results.

Conclusion

Legislations remain some of the most effective policy tools for advancing patient
care. The Medicare Prescription Drug Savings and Choice Act of 2019 promises to be an
important law that will improve health outcomes for the elderly and the disabled who are
covered by Medicare. However, given the power of the drug companies, there is high
likelihood that the final law may be significantly watered down to the extent of making it
ineffective in controlling drug prices.

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References

Kang, S. Y., Bai, G., DiStefano, M. J., Socal, M. P., Yehia, F., & Anderson, G. F. (2020).
Comparative Approaches to Drug Pricing. Annual Review of Public Health, 41,
499-512.

Kesselheim, A. S., Avorn, J., & Sarpatwari, A. (2016). The high cost of prescription
drugs in the United States: origins and prospects for reform. Jama, 316(8), 858-

871. doi:10.1001/jama.2016.11237.

Medicare Prescription Drug Savings and Choice Act, H.R.4769, 116 th Cong. (2019).
https://www.congress.gov/bill/116th-congress/house-
bill/4769?q=%7B%22search%22%3A%5B%22H.R.4769%22%5D%7D&r=1&s=
1

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th
ed.). Burlington, MA: Jones & Bartlett Learning.

Schakowsky, J. (2020, Dec. 3). We Must Act on Lowering Cost of Prescription Drugs.
House.gov. Retrieved on December 23, 2020 from
https://schakowsky.house.gov/media/editorials/we-must-act-lowering-cost-
prescription-drugs