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Senators press Obama administration on efforts to lower prescription drug costs

congressU.S. Sens. Mark R. Warner (D-VA), Bill Nelson (D-FL), Jeanne Shaheen (D-NH), Heidi Heitkamp (D-ND), and Tim Kaine (D-VA) wrote to Centers for Medicare & Medicaid Services Acting Administrator Andrew Slavitt, seeking more information on the agency’s efforts to inform consumers and health care providers about prescription drug costs and maximize CMS’ existing authorities to contain cost.

“In 2014 alone, spending on prescription drugs rose by 12.2%.  Inevitably, these rising costs squeeze American household budgets as well as federal and state budgets, Medicare, Medicaid, and other public health care programs that use taxpayer dollars to pay for drugs,” the Senators wrote. “There are numerous reasons why patients and heath care payers are experiencing rising prescription drug costs, and the solutions are not simple.”

In the letter, the Senators asked CMS for more information on how the agency expects to use its existing authority to improve transparency on drug pricing and bring down drug costs. They pose a series of questions about the existing authority of CMS to halt rising drug prices, along with understanding how the Department as a whole can leverage information to better assess the effectiveness of treatments and provide better information to consumers about their options. Questions include:

  • How does CMS plan to leverage the authority of the Center for Medicare and Medicaid Innovation (CMMI) to examine the potential of alternative payment mechanisms, including examining methods to increase use of and access to competitive generic medications, and alternatives to the current ‘ASP+6%’ model?
  • A number of outside, independent organizations and researchers including the Patient Centered Outcomes Research Institute (PCORI) and the Institute for Clinical and Economic Review (ICER) are assessing the comparative effectiveness of various treatments. How can CMS use this information to improve beneficiary outcomes and lower program spending?
  • Within the individual private insurance market, an increasing number of consumers are enrolling in high-deductible plans. How does CMS plan to continue to use its regulatory authority to ensure consumer access to prescription drugs on the individual market?