I built a small business in my hometown into a national company, and I saw firsthand how broken our health insurance system is as a business owner trying to insure my employees.
I decided to self-insure after too many years of hearing my underwriter tell me, “You’re lucky your costs are only going up 15 percent this year.” I took on Big Health care and built a plan for my employees based on two guiding principles: No one should go broke because they get sick or have a bad accident, and my employees should be empowered to take ownership in their own health care by shopping around for the best prices for services and prescriptions.
The lessons I learned from taking on the health care industry in my own company led me to take on Big Health care in the US Senate, and the principles of forcing price transparency, cutting red tape, encouraging innovation, and facilitating fierce market competition have inspired the four health care reform bills I’ve reintroduced.
Drug Price Transparency Act
Pharmacy Benefit Managers, or PBMs, act as middlemen between drug manufacturers and patients to administer prescription drug benefits and negotiate rebates. The current system allows for PBMs to pocket an undisclosed portion of rebates, causing drug manufacturers to raise prices to account for PBMs’ cut off the top. These misaligned industry incentives and murky pricing maneuvers force patients to shoulder the burden of increasing drug prices.
My first bill, the Drug Price Transparency Act would pull back the curtain on this broken system, and require insurers and PBMs to pass rebates directly to consumers enrolled in commercial health plans and Medicare Part D, incorporating HHS’s Rebate Rule, finalized last year.
My Drug Price Transparency Act establishes two new requirements to qualify for safe harbor for rebates: one for rebates which are passed on to patients at the point of sale, and the other for flat service fee payments made to PBMs, which cannot be tied to the list price of drugs. Just like in any other market, knowing the price of a product before you have to pay it empowers consumers to shop around for the best price, leading to lower prescription drug list prices and reduced out-of-pocket payments for patients.
Health Care PRICE Transparency Act
Hospitals and insurers have long taken advantage of the health care industry’s misaligned incentives that promote opaque pricing maneuvers to increase their profits, with patients footing the bill. Price transparency would empower patients to make more informed decisions when making health care choices, and increase competition among hospitals, group health plans, and insurance issuers in the individual and group markets to lower costs and improve the quality of health care services.
President Donald Trump made great progress toward health care price transparency through executive actions. My Health Care PRICE Transparency Act would build on this work by codifying two US Department of Health and Human Services (HHS) final rules, Hospital Price Transparency, and Transparency in Coverage. My bill requires hospitals to disclose the cost of an item or service set by the hospital and establish an internet-based price estimator. It also requires insurers to provide consumers with personalized access to cost-sharing information so they can compare costs and know what they have to pay before they pay it.
Promising Pathway Act
Americans with serious and life-threatening diseases don’t have time to wait for the slow pace of Washington, DC, and for many of the millions of families fighting terminal illnesses, access to experimental treatments is their only hope.
My Promising Pathway Act will speed up the regulatory process for getting drugs to the patients that need them with an FDA provisional approval pathway for rapidly progressing conditions where few treatment options exist, such as ALS.
Under this provisional approval, those with rapidly progressing terminal illnesses would have access to drugs that provide their only hope for treatment, and real-world data collected from these patients would be incorporated into the drug approval process.
Accelerated Drug Approval for Prescription Therapies (ADAPT) Act
We have a drug shortage problem in America, and we need to cut red tape – not cut corners – to get safe and effective drugs to market efficiently.
My ADAPT Act would create an expedited drug approval process at FDA, specifically for drugs that are currently approved for sale in developed countries and have a satisfactory history of clinical trial data.
Think of it as a passing lane for drugs and treatments that have already been approved in other developed countries like Canada and the UK with strong clinical data focused on quality control, supply chain safety, and manufacturing processes, without compromising one bit on FDA’s safety and efficacy standards.
While many in Congress want to solve these drug shortage problems with drug importation, the ADAPT Act is a better solution that would help solve this problem and increase market competition between drugs on the marketplace without compromising on safety.
Americans are clamoring for real solutions on health care, and the lessons I learned in the real world by taking on the health care industry in my company – and the stories I’ve heard from Hoosiers struggling with rising costs and dwindling options – inspired these four solutions that will inject transparency, competition, and efficiency into our broken health care system, and help steer America off our collision course with socialized medicine.
Congress must listen to the voices I hear every time I travel Indiana calling for action on real health care solutions rather than more talk and bigger government, before it’s too late.
