Government Price Setting Has Potentially Devastating Consequences for Patients

Government price-setting policies come in a variety of forms, but they all lead to the government inserting itself between patients and providers, threatening access to treatments and chilling research and development of new medicines. In fact, in other countries that have resorted to government price setting, patients have access to fewer new medicines and wait longer to get the medicines they need. Instead of pursuing proposals that could hurt patients and cripple innovation, we need policies that protect access to treatments and make medicines more affordable.

Medicare “Negotiation”

A pharmacist explains the label of a medication bottle to an older patient

Members of Congress continue to push a misguided drug pricing proposal under the guise of negotiation and addressing inflation as part of the reconciliation package. This proposal is nothing short of government price setting and, if implemented, would require the government to dictate prices and choose winners and losers when it comes to which diseases are likely to see new treatments. Instead of addressing a broken insurance system, the most recent proposal doubles down on bad policies that will threaten patient access to medicines and future innovations.

Prescription Drug Affordability Boards

Prescription drug affordability boards give bureaucrats the power to arbitrarily set medication prices in a given state. As a result, decisions about medicines would be a part of a political process that changes with elections and the whims of politicians.

Under this policy, the state would evaluate whether certain medicines and treatments are “worth” paying for, meaning the state’s bureaucracy could come between patients and the treatments their doctors prescribe. This spells disaster for patients as they could face barriers to obtaining life-saving medication.

Government price setting threatens families’ access to the medicine they need

Photograph of Emily Hanson, PhRMA advocate
Ensuring A Better Future For Her Child: Emily H

Caring for a child with a serious illness isn’t easy. "It took us a long time to get answers for him—9 years. And it took going across the country to a specialty clinic." Now Emily is raising her voice to ensure that her son and kids across the country have access to the medicines and new innovation they need.

Patients Like Olga Worry Congress Might Compromise Access to Medicines by Meddling with Medicare

Olga is a senior who feels blessed to have gotten the Covid-19 vaccine. But she is worried now that Congress might meddle with her Medicare and make changes that threaten her access to medicines.

Patients Like Sue Worry Congress is Compromising Access to Medicines by Meddling with Medicare

Sue is a patient with Type 1 diabetes who depends on Medicare to get her medicines. It’s not always easy. Now some in Congress want to make it harder for patients like Sue to access her medicines. There’s a better way to fix health care for patients.

Myth Vs. Fact: Government Price Setting in Medicare Part D

In Medicare Part D, negotiations between pharmaceutical manufacturers and insurance companies help lower what patients pay for prescription medicines. But some in Congress want to permit the government to intervene in these negotiations, risking patient access and choice as well as future innovation.

What politicians say about negotiating prices in Medicare vs. What they mean

Politicians say they’ll negotiate medicine prices in Medicare. But what they mean is that they’ll decide which medicines you can and can’t get. And it could lead to long waits in Medicare for new treatments and cures.

Building a Better Health Care System

Americans deserve better solutions than government price-setting that would help make medicines more affordable for patients without upending the health care system or jeopardizing American innovation. For Medicare Part D, these include capping annual out-of-pocket costs for medicines, lowering cost-sharing, making out-of-pocket costs more predictable throughout the year, and ensuring savings negotiated with health plans and PBMs are passed on to patients at the pharmacy counter.

In the commercial market, insurance should work like insurance, sharing negotiated savings with patients at the pharmacy counter, ensuring cost-sharing assistance applies to out-of-pocket maximums, covering more medicines from day one and making out-of-pocket costs more predictable.

Our goal should be lowering out-of-pocket costs and improving patient access through commonsense, patient-centered solutions that don’t upend the health care system or American innovation. Government price setting isn’t the answer.