The House of Representatives approved a bill last month allowing the
federal government to negotiate with pharmaceutical companies over the price
of drugs offered in the Medicare Part D prescription drug program.
The bill, which was approved by a vote of 255-170, is expected to have a
much harder time in the Senate. At press time, APA Director of Government
Relations Nicholas Meyers told Psychiatric News, "It does not
seem likely that the House bill will pass the Senate without
He noted that Senate Finance Committee Chair Max Baucus (D-Mont.) has"
expressed concerns about the legislation as it is now written and has
called for some compromises."
The bill, the Medicare Prescription Drug Price Negotiation Act of 2007 (HR
4), states that the secretary of Health and Human Services (HHS) "shall
negotiate with pharmaceutical manufacturers the prices (including discounts,
rebates, and other price concessions) that may be charged to prescription drug
plan sponsors and Medicare Advantage organizations for covered Part D drugs
for Part D—eligible individuals who are enrolled under a prescription
drug plan or under [a Medicare Advantage] plan."
The inability of the government, representing millions of Medicare
patients, to negotiate for lower prices has been a source of contention since
passage of the Medicare prescription drug program in 2003. Opponents of the
legislation claimed then that by prohibiting the government from negotiating
over price, it paved the way for a bonanza for the pharmaceutical
APA has not taken a position on the bill, though in the run-up to its
passage, it continued to advocate for access to psychiatric medications,
whatever the outcome of the House vote. In a January 12 letter to House
Speaker Nancy Pelosi (D-Calif.) and other House leaders, APA Medical Director
James H. Scully Jr., M.D., urged House members to ensure that the legislation"
does not carry the unintended consequence of limiting beneficiary
access to important medications."
Meyers told Psychiatric News that the drug-pricing discussions are
part of a larger debate about access to care.
"Access to the full range of medications psychiatrists use to treat
their patients is also critical, which is why we have worked hard with the
National Alliance on Mental Illness, Mental Health America, and others to
ensure that the Part D implementation did not result in potentially
catastrophic interruptions in, or abrupt switching of, psychotropic
medications," he said.
He added that Scully's letter was intended to remind House leaders that the
government has thus far protected psychiatric drugs in the Medicare
prescription drug program and that enactment of drug-negotiation legislation
does not change the need for continued protection.
"We also recognize that the best medications in the world aren't
going to work if patients can't afford them, which is why we joined with other
medical specialties and patient groups in actively supporting the Partnership
for Prescription Assistance," Meyers said. "The PPA doesn't solve
the drug-pricing debate, but it does bring immediate help to patients who have
trouble paying for their medicine."
The Partnership for Prescription Assistance offers a single point of access
to more than 475 public and private patient-assistance programs, including
more than 150 programs offered by pharmaceutical companies. It is supported by
member companies in Pharmaceutical Research and Manufacturers of America
(PHRMA) and medical and health care advocacy organizations, including APA.
Predictably, the Bush administration and the pharmaceutical industry did
not respond favorably to news of the bill's passage.
HHS Secretary Mike Leavitt noted in a statement that the Congressional
Budget Office had determined that the legislation would not result in lower
"I am disappointed that a majority of House members discounted the
overwhelming success of the Medicare Part D program over the last year and
voted to pass HR 4," Leavitt said. "Despite statements from the
nonpartisan Congressional Budget Office and the independent Centers for
Medicare and Medicaid Services' actuaries that this legislation would not
result in savings, this legislation was hastily adopted without hearings in
the House. We hope that the Senate will reflect on the evidence and resist the
temptation to undermine a program that is working well for millions of people
The Pharmaceutical Care Management Association, in a statement released
after the House action, said passage of the bill "would take the
Medicare drug benefit in the wrong direction and potentially shift additional
costs to private and public payers, including Medicaid and the Veterans
The text of HR 4 can be accessed at<http://thomas.loc.gov/cgi-bin/Thomas>
by searching on the bill number. Information about the Partnership for
Prescription Assistance is posted at<www.pparx.org/Intro.php>.▪