The rising cost of prescription medications has prompted lawmakers to seek solutions aimed at reducing expenses for American patients. As Congress investigates the intricate supply chain that dictates how drugs are priced and delivered, critical questions arise: How can launch prices be decreased, and how can unjustified price hikes be curbed? Moreover, increasing market competition is essential to lower premiums and out-of-pocket costs for consumers.
Currently, health insurance providers serve as one of the few checks on escalating drug prices. Blue Cross Blue Shield Association (BCBSA) emphasizes that rising premiums reflect the increasing costs of medical care rather than insurers squeezing consumers. As new drugs are introduced with significantly high launch and list prices, these costs inevitably impact premiums and the out-of-pocket expenses faced by families.
A recent survey found that over 90 percent of U.S. voters are worried about the cost of prescription drugs, with 69 percent identifying medication prices as one of their top concerns. High costs are often attributed to manufacturers setting exorbitant prices, increasing them regularly, and obstructing access to more affordable alternatives.
BCBSA and several Blue Plans have initiated CivicaScript, a program designed to provide affordable versions of commonly prescribed but overpriced generic medications to the market, thereby fostering competition. A study published in the New England Journal of Medicine Catalyst revealed that CivicaScript’s generic prostate cancer drug saved patients nearly $1,000 annually. Earlier this year, the Civica Foundation began offering affordable insulin pens, capping prices at $55 per box of five pens, compared to the typical market price of $150–$500.
Policymakers are also taking steps to address these challenges. In a recent budget agreement, Congress passed the Increasing Transparency in Generic Drug Applications Act, a bipartisan effort that aims to expedite the approval process for generic drugs. Additionally, former President Donald Trump recently launched the TrumpRx initiative, highlighting the urgency of reducing drug prices for American families without insurance coverage.
The Centers for Medicare and Medicaid Services have made strides by lowering out-of-pocket costs for patients receiving physician-administered drugs, marking a positive step towards practical policymaking that can provide genuine relief.
There remains an opportunity for Congress to further expand competition and tackle the root causes of rising costs. Bipartisan legislation is already on the table, which includes measures to eliminate patent thickets and end pay-for-delay schemes, ultimately benefiting patients with more choices at reduced costs.
As the House Energy and Commerce Subcommittee on Health convenes to discuss drug pricing, it is hoped that these solutions will be central to their deliberations. By addressing these pressing issues, lawmakers can deliver much-needed relief to Americans burdened by ever-increasing medication prices.
