Dr Joe Antos Dissects the Challenge of Addressing Drug Prices

The way Washington, DC, works will make it difficult to enact any meaningful change that will cause a difference in how much patients pay for prescription drugs, said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.

How well do you think Congress and the Trump administration are pursuing policies to curb the cost of prescription drugs?
Prescription drug prices and costs are the same thing for most people. This is a huge issue in Washington, DC. It’s equally a huge issue at the pharmacy counter for the average person. Especially older people who tend to need more prescription drugs. It’s a big, big issue.

I think, as usual, Washington kind of has it wrong. What matters to the average patient is not what the overall price is, not what the list price is, it has nothing to do with the strange machinations of PBMs [pharmacy benefit managers] or drug companies or retail pharmacies. It has to do with when you go to the pharmacist and you pull out your credit card, how much do they want out of you? That’s the issue.

And I don’t think that Washington politics operates on that level that the average consumer would detect anything. For example, the administration, and also Congress, has been talking about somehow getting the rebates that are in the system behind the scenes to the patient when he or she picks up the prescription. The problem with that is: A) it’s impossible to know what that amount is; B) the likely amount per prescription is a very, very small number; C) from a political standpoint, and this is all that really matters, the average patient doesn’t know what they were going to pay in the first place. So, when you say you got $2 off: A) big deal; B) $2 off of what?

So, I think as a political move, there’s nothing there. As a move in terms of trying to get what people call greater transparency in pricing, it also kind of misses the point. Because the issue is not rebates, per say, but what the flow of funds are and who gets to keep the money among the many, many intermediaries between the drug manufacturer and the patient. There are a lot of people involved, everybody gets their cut. Where does the money go? Is there accountability? The answer is we don’t know.
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