In calling prices for obesity and diabetes medications such as semaglutide (Wegovy, Ozempic) “outrageous” and “unconscionably high,” President Joe Biden and Sen. Bernie Sanders (I.-Vt.) are engaging in a familiar, misguided discourse on prescription drug prices — in this case, they’re targeting a class of weight loss drugs called glucagon-like peptide-1 (GLP-1) receptor agonists.
We have heard this before with regard to vaccines and insulin. Consider Sen. Sanders’ COVID-19 vaccine rhetoric, which has been cited as misleading with regard to the degree of public investment in the vaccines and policies that shielded patients from paying exorbitant prices. Despite this, Sanders has even gone as far as threatening to subpoena pharmaceutical CEOs over high drug prices, a virtually unprecedented move in the history of the Senate Committee on Health, Education, Labor, & Pensions (HELP).
In an op-ed earlier this month, the president and senator together claimed, “There is no rational reason why, for decades, 1 out of 4 Americans have been unable to afford the medicine their doctors prescribe.”
In the grand scheme of things, that’s a fair point. But GLP-1s — offered as a key example in the op-ed — have only become widely used as an obesity treatment more recently. They’re simply a convenient target, given their broad media attention. While we can easily agree that patients should be able to afford drugs, the commercial list price of GLP-1 medications is not the root of the problem — unmitigated patient cost-sharing is. Congress knows this and, for this reason, has over time limited cost-sharing to ensure patient affordability.
Policymakers have the tools to make drugs, including GLP-1s, affordable to patients while preserving a biopharmaceutical marketplace that is vital to innovation and access. Leveraging those tools should be a priority.
First, consider the magnitude of the obesity epidemic in America, where 42% of adults are obese, costing $173 billion annually in excess healthcare costs. Meanwhile, 38 million Americans are living with diabetes, costing $413 billion in healthcare and economic losses.
Now consider the astounding benefits of GLP-1s: improving the management of type 2 diabetes and reversing obesity and metabolic disorders. Research into their potential to treat substance abuse disorders is encouraging and ongoing. The government should be doing everything in its power to broaden access.
The Power of Policymakers
Congress took a major step under the Affordable Care Act (ACA), which then-Vice President Biden and Sen. Sanders supported, to limit the drug costs health insurance companies are allowed to pass on to patients. The ACA also dictates that certain recommended preventive care must be covered with zero out-of-pocket costs to the patient.
A colleague and I have suggested that this framework could be used to make insulin and GLP-1s free to patients who meet the criteria for its use. The U.S. Preventive Services Task Force would need to review the available evidence and recommended GLP-1s with an A or B rating to activate mandatory coverage without cost-sharing. It has already done this for statins and pre-exposure prophylaxis for HIV prevention in certain groups.
The Inflation Reduction Act (IRA), President Biden’s signature legislative achievement, singled out insulin, capping Medicare beneficiary costs at $35 per month. This unusually specific provision followed the rhetoric of Sen. Sanders about the cost of insulin. Perhaps he could consider a similar provision for other essential medicines, like GLP-1s for diabetes, obesity, and cardiovascular disease.
The IRA also capped the annual out-of-pocket costs seniors pay for drugs at $2,000. President Biden has suggested he wants to extend this cap to other insurers.
Policies such as these — that limit the costs that payers can pass on to patients — remove cost as a barrier to essential medicines. They ensure that patients can afford medication. Yet President Biden and Sen. Sanders are not content with using these available tools to lower costs to patients.
Instead, they focus on price-setting and vilifying the innovations that lead to lifesaving medication. The government will eventually have its opportunity to negotiate GLP-1 prices under the IRA’s price-setting framework. But President Biden and Sen. Sanders want to expand the reach of their price-setting policy — by developing new legislation to negotiate more drugs than the IRA currently allows — so they focus on convincing Americans that pharmaceutical companies are robbing their pockets.
What’s Missing From the Narrative
Nowhere in the op-ed do President Biden and Sen. Sanders acknowledge that the retail price of a drug is generally not the price that is ultimately passed on to the consumer. Nor do they acknowledge the discounts provided by manufacturers that patients never see or the fact that existing exclusivity policies cap the number of years a drugmaker can sustain a price point. Also lost is the role of payers in gatekeeping access to these innovative, life-changing medicines through practices such as prior authorization that may provide a stopgap against inappropriate use, but also keep drugs out of reach for otherwise eligible patients.
The president and senator are quick to dismiss the realities of lost innovation associated with their hardball policy tactics. The U.S. need only look at Europe’s slide in life sciences innovation relative to the U.S. to understand these realities. Do we really want to face our own innovation downfall?
Ensuring patients can afford drugs does not have to come at the cost of innovation. Health insurance companies and policymakers have the keys to lower patient costs. If President Biden and Sen. Sanders are serious about making GLP-1s affordable, they have the tools, and those don’t involve scare tactics and puffery over retail drug prices.
Richard Hughes IV, JD, MPH, is an attorney in Washington, D.C., and a professorial lecturer in law at The George Washington University Law School.
Disclosures
Hughes served as vice president of Public Policy at Moderna during the pandemic; he regularly advises biopharmaceutical companies. The views expressed here are his own.
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