Trump’s Rule of Chaos Will Improve Drug Price Transparency

This article as first published on LinkedIn on June 17, 2019.

Last week, three drug companies sued the Centers for Medicare and Medicaid Services (CMS) in an effort to reverse a Trump administration ruling that requires drug companies to post list prices for their drugs in television ads. The rule is supposed to go into effect in July.

Americans want more clarity regarding drug prices. But many argue that posting list prices on T.V. is not the way to provide it. That’s because the list price for a drug has very little to do with what a patient actually pays for a drug. Depending on the patient’s insurance coverage, age, income level, pharmacy, whether s/he has a coupon or discount card or rebate opportunity…myriad factors impact the out-of-pocket price for medication.

So why post the list price? To create chaos, with the ultimate intent of coming to a new and unexpected solution. The rule of chaos is President Trump’s modus operendi. He throws out the norms – which largely relate to telling people what he’s going to do before he does it – and rolls out policy real-time via Twitter. This approach puts everyone off balance. Amidst the confusion, it is his voice and his goal that bubbles to the top and everyone else is charged with reacting to what he wants.

Let’s look at what happened this month with the proposed tariffs on Mexico. President Trump has been condemning the wave of migrants coming into the U.S. through Mexico from Central America. Rather than stick to the old-school negotiations which had been underway for months, Trump went nuclear. He announced an aggressive schedule of tariffs on Mexico, our neighbor and ally. Blowback was intense. And then a deal was signed.

Discussions have been ongoing for years between Health and Human Services (HHS), CMS, insurance companies and pharmaceutical manufacturers about improving drug pricing. Yet consumers aren’t any closer to understanding what their drugs will cost. So the Trump administration is trying to change the rules of the game and this T.V. ad approach is part of the plan.

It’s not a perfect idea. Chaos is sure to ensue and it’s another indicator that things in health care are going to continue to get worse before they get any better. My empathy goes out to the doctors and the first-line providers. They’re the ones who are going to shoulder patient complaints and confusion. Their time with patients is precious and rather than spend it on patient care, they’ll talk about the lunacy of list pricing.

Yet in the macro-scheme, the T.V. ad campaign will generate pressure on the industry in ways we haven’t seen before…because no one’s ever done this before. The health care industry needs jolts and shocks that engage and empower consumers. I, for one, can’t wait to see a video mash-up comparing the list price of the world’s best-selling drug, Humira, to its competition in the rheumatoid arthritis treatment market. Same thing for the EpiPen. Or even birth control pills. We could have a new YouTube channel on our hands.

As patients, let’s continue to educate ourselves, support each other and demand change from the health care industry. We deserve better than chaos. But until someone comes up with anything better, that’s what we’ve got.

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