Lankford Tackles High Rx Prices

OKLAHOMA CITY, OK – Senator James Lankford (R-OK), who serves on the Senate Finance Committee which has jurisdiction over the Centers for Medicare and Medicaid Services (CMS), introduced two vitally important bills to tackle the biggest drivers of the high cost of prescription drugs, particularly for senior adults on Medicare: the Ensuring Access to Lower-Cost Medicines for Seniors Act and the Prescription Drug Supply Chain Pricing Transparency Act.

Lankford introduced the Ensuring Access to Lower-Cost Medicines for Seniors Act in partnership with Senator Bob Menendez (D-NJ), a senior member on the Senate Finance Committee. This bipartisan bill would ensure that patients can finally benefit from lower-cost products instead of being forced to pay for higher-priced drugs solely because of pricing gimmicks used by pharmacy benefit managers (PBMs), the drug pricing middlemen. This legislation would clearly establish pricing “tiers” to separate lower-cost generic drugs and biosimilar products from name-brand drugs so that patients pay less out of pocket for truly lower-priced drugs, therefore incentivizing prices to drop in order to get into the hands of patients.

“Most Oklahomans and people around the country do not know that because of complex and unfair pricing practices, sometimes a generic drug—which they think should come with a lower price tag at the pharmacy counter—actually costs as much or more than the brand name drug product, if it is covered by insurance at all. That’s not right,” said Lankford. “My bill requires cheaper generic or biosimilar drugs to be offered at a lower price than name-brand drugs. It’s a simple solution that should not be controversial. We need to get this passed immediately to address unfair pricing gimmicks that only hurts patients at the pharmacy counter.” 

“I’m proud to be working with Sen. Lankford on this bipartisan solution, which takes on PBM discriminatory formulary practices that unfairly drive up the costs of prescription drugs for seniors on Medicare Part D,” said Menendez. “I am committed to lower costs for my constituents and Americans all across the country at the pharmacy counter, and this legislation is another step towards reforming PBMs so they cannot continue gaming the system on the backs of patients.” 

The Ensuring Access to Lower-Cost Medicines for Seniors Act requires:

  • Medicare Part D to cover a generic or biosimilar if it costs less than its name-brand counterpart.
  • Generic drugs or biosimilars to be placed on a generic/biosimilar formulary pricing tier and name-brand drugs to be placed on a brand tier, with the generic tier having a lower insurance cost-sharing requirement for patients than the name-brand tier.
  • A new tier for specialty generics or biosimilars that would also have a lower insurance cost-sharing requirement for patients.

Lankford also introduced with Senator Michael Bennet (D-CO), a member of the Finance Committee, the Prescription Drug Supply Chain Pricing Transparency Act to require the Government Accountability Office (GAO) to conduct a study and submit a report to Congress about the ways the current drug-pricing supply chain structure actually incentivizes drug manufacturers, PBMs, and insurance companies to price drugs higher. The required GAO report would look at the payment structures across the prescription drug supply chain, as well as their implications for taxpayer spending, patient out-of-pocket costs, and potential conflicts of interest.

“I’ve said it many times: Congress can’t fix what we can’t see, and the dark alley of prescription drug pricing is an area that needs as much sunlight as possible,” said Lankford. “A lack of information and reluctance on the part of those involved in pricing prescription drugs have made it difficult for Congress to provide oversight and make positive change. Our bill helps Congress better understand the realities of drug pricing scheme so we can better untangle the messy, complicated system in favor of better patient access and affordable prices for patients at the pharmacy counter.”

“Lifesaving medicine is still unaffordable for far too many Americans. This bill is an important step toward increasing transparency in the drug pricing supply chain and making high-quality health care more accessible for every American,” said Bennet.

Lankford,  Menendez, and Bennet remain long-time advocates for practical solutions that bring down the cost of prescription drugs at the pharmacy counter, especially for senior adults on Medicare. At a recent Senate Finance Committee hearing, Lankford pressed the witnesses about practices PBMs use to limit access to lower-cost generic drugs, manipulating Medicare Part D health plans’ formulary tiers to usurp patients’, doctors’, and pharmacists’ expertise, sometimes forcing a patient to pay for a higher-cost brand-name drug even when a cheaper option is available.

This week, Lankford also introduced the Protect Patient Access to Pharmacies Act, which will ensure that all pharmacy price concessions, including fees imposed by PBMs are assessed at the point of sale and ensure that pharmacies will have proper access to performance metrics so they are able to remain serving Medicare patients.