Legislators are exploring strategies to alleviate the burden of high prescription drug costs for Americans. As Congress evaluates the intricacies of the prescription drug supply chain, key questions arise: How can launch prices be reduced, and what measures can curb unjustified price increases? Additionally, boosting market competition may lead to lower premiums and reduced out-of-pocket expenses for patients.
Currently, health insurance providers serve as one of the few mechanisms to regulate drug pricing. According to the Blue Cross Blue Shield Association (BCBSA), securing fair prices is crucial for families. Rising medical care costs, rather than insurer actions, primarily drive premium increases. When new medications enter the market at exorbitant prices, these costs inevitably impact premiums and patient bills.
Prescription drug costs are a pressing concern for many Americans. Recent surveys indicate that approximately 90 percent of U.S. voters express worry about medication prices, with 69 percent identifying it as one of their top health-related concerns. The high cost of prescriptions often stems from manufacturers setting prices excessively high and frequently raising them while simultaneously blocking access to more affordable alternatives.
To address this issue, BCBSA, along with several Blue Plans, initiated CivicaScript, aimed at providing cost-effective versions of essential but overpriced generic medications. A study published in the New England Journal of Medicine Catalyst found that CivicaScript’s generic prostate cancer medication helped patients save nearly $1,000 annually. Earlier this year, the Civica Foundation launched affordable insulin pens, capping prices at $55 per box of five pens, significantly lower than the typical price range of $150 to $500.
In addition to private sector efforts, policymakers are also taking action. The recent budget agreement in Congress included the passage of the Increasing Transparency in Generic Drug Applications Act, a bipartisan measure designed to expedite the approval process for generic drugs. Furthermore, President Donald Trump recently introduced TrumpRx, an initiative aimed at reducing drug prices for uninsured Americans. This initiative is expected to benefit millions who currently lack insurance coverage.
BCBSA has also endorsed the administration’s initial steps towards site-neutral reform, which the Centers for Medicare and Medicaid Services implemented to lower out-of-pocket costs for patients receiving physician-administered drugs. Such practical policy measures can bring tangible relief to those struggling with high medication expenses.
There remain additional legislative opportunities for Congress to enhance competition and tackle the root causes of rising drug costs. Current bipartisan proposals include addressing issues such as patent thickets and eliminating pay-for-delay schemes, which hinder patient access to affordable medications.
As the House Energy and Commerce Subcommittee on Health convenes to discuss drug pricing, it is hoped that these solutions will be central to the conversation. By focusing on targeted, bipartisan initiatives, lawmakers can provide much-needed relief to Americans who are frustrated with escalating medication prices.
David Merritt serves as the senior vice president of external affairs at the Blue Cross Blue Shield Association. The opinions expressed in this article are those of the author and do not necessarily reflect those of the organization.
