The document discusses the prescription drug price crisis in the United States. Drug prices have risen much faster than general inflation over the past decade, and millions of Americans cannot afford necessary medications as a result. The U.S. pays significantly higher prices for many drugs than other countries. Several policy solutions are proposed to lower drug costs, including allowing Medicare to negotiate drug prices, banning "pay-for-delay" deals between drug companies, and legalizing importation of lower-cost drugs from abroad. Advocacy groups are calling for stronger political action to enact reforms and lower what Americans pay for prescription medications.

1. The Prescription Drug Price Crisis
Gabriel Levitt
PharmacyChecker, President & Co-founder
Prescription Justice, Founder
gabriel.levitt@pharmacychecker.com

2. Drug Prices are a Crisis
•45 million Americans did not fill prescriptions in 2016
because of cost
•Top 20 Medicare drugs rose ten times the rate of
inflation
•Specialty drugs frequently cost $100,000+
•Government programs are rationing medications
•Public opinion: 80% say drug prices are unreasonable

3. Consumer Price Index vs. Drug Price Inflation
2006 - 2015
Consumer
Price Index
21.6%
Drug Price
Inflation
172.1%
DATA SOURCE: Rx Price Watch Report 2016-04, December 2016. Brand-name drug
inflation; based on 268 top drug products taken by older Americans.

4. U.S. vs Other Countries
A Closer Look: 45 million Americans did not fill a prescription in 2016 because of cost
Source: R. Osborn, D. Squires, M. M. Doty, D. O. Sarnak, and E. C. Schneider, "In New Survey of 11 Countries, U.S. Adults Still Struggle with Access to and
Affordability of Health Care," Health Affairs Web First, Nov. 16, 2016. [Last accessed 1/20/2017]; and U.S. Census Bureau data:
https://www.census.gov/quickfacts/table/PST045216/00Based: 18% of the adult population in 2016.
Country AUS CAN FR GER NET NZ NOR SWE SWIZ UK US
Percentage
that did not fill
prescriptions due
to cost 6% 10% 4% 3% 4% 6% 3% 6% 9% 2% 18%

5. Drug Price Insanity
Super Expensive Drugs
Sovaldi – Hepatitis C – $1,000 per pill
Kymriah – Acute Lymphoblastic Leukemia – $475,000 for one infusion
Emflaza – Duchenne Muscular Dystrophy – $100,000 per year
Widely-prescribed Expensive Drugs
Advair Diskus – asthma – $1437 for a three-month supply
Januvia – type 2 diabetes – $1593 for a three-month supply
Zetia – high cholesterol – $1261 for a three-month supply

6. Online Drug Price Comparisons
Drug U.S. Price International Price International Savings
Advair Diskus 250/50mcg
Condition: Asthma and COPD
$1,437.00 $72.93 95%
Zetia 10mg
Condition: High Cholesterol
$1,260.90 $150.30 88%
Januvia 100mg
Condition: Type-2 Diabetes
$1,593.90 $72.90 95%
Daraprim 25mg (six tablets)
Condition: Toxoplasmosis
$4,469.07
(with coupon)
$6.48 99.9%
Epipen (two 0.3mg pens)
Condition: Asthma / Allergy
$700 $167.99 77%

7. Consequences of High Drug Prices
• Cancer patients are 2.5 times more likely to become
bankrupt
• Health insurance premiums increase
• Federal and state budgets are under siege
• Millions of people skipping or not taking their
medications can get sick and die

8. Why are drug prices so damn high?
• Monopoly pricing power
• Medicare must cover every FDA-approved drug and can’t negotiate
prices
• Middlemen are taking a cut
• Importation of the same drug at lower-cost is technically not
allowed
• Patent games (evergreening, pay-for-delay, withholding ingredients)
• Generic drug backlog

9. Greed is NOT Good

10. Big Pharma Lobbying
Industry Total (1998 –present)
Pharmaceuticals/Health Products $3,872,801,120
Insurance $2,664,571,126
Electric Utilities $2,323,692,291
Electronics Mfg & Equip $2,192,712,141
Business Associations $2,188,649,807
Oil & Gas $2,064,871,172

11. Trump’s Blue Print on Drug Prices
• Change system of PBM rebates so that more savings are passed on to
patients
• More tools and competition to lower costs in Medicare Part B
• Allow Step-therapy
• End incentives for doctors to administer the most expensive drugs
• Paying for value. With this policy, drug companies would get paid
when the drugs work.
• Using trade agreements to raise drug prices in other countries
• Bolster competition in biosimilars

12. Prescription Justice Policy Platform
• Medicare drug price negotiations
• End pay-for-delay
• Legalize importation of lower-cost medication
• Protect personal drug imports

13. Medicare Drug Price Negotiations
• The largest prescription drug program in the world is Medicare’s Part D & B
• $162 billion was spent on medication for Medicare enrollees in 2015
• Total world spending on medicines was about $1,000,000,000,000 in 2015
• 1% of the population is responsible for about 16% of all Rx spending
• Current law bans Medicare from negotiations
• Medicaid and the Veterans Health Administration negotiate and set prices.
• Savings: A fair estimate is that $20-25 billion per year would be saved if
drug prices were similar to those in Medicaid and the VHA.

14. Medicare Drug Price Negotiation Bills
Medicare Drug Price Negotiation Act, S. 2011 and H.R. 4138
• October 25th, 2017
• Senate Sponsor: Senator Bernie Sanders (I-VT); 7 co-sponsors
• House Sponsor: Rep. Elijah Cummings (D-MD); 18 co-sponsors
Medicare Negotiation and Competitive Licensing Act H.R. 6505
• July 25th, 2018
• Sponsor: Lloyd Doggett (D-TX),
• 85 co-sponsors

15. Banning Pay-for-Delay Deals
• Brand-name drug companies pay generic drug companies not to introduce
a generic alternative
• In 2010, FTC estimated that the cost to consumers and taxpayers is $3.5
billion a year
• A 2013 supreme court decision opened the door to challenging pay-for-
delay deals but they are still not illegal
• Pay-for-delay deals have decreased but continue to deprive patients of
lower-cost generic medications

16. Preserve Access to Affordable Generics Act of 2017
S. 124
• Sponsor: Senator Amy Klobuchar (D-MN)
• 1 co-sponsors – Chuck Grassley (R-IA)
(1) to enhance competition in the pharmaceutical market by stopping
anticompetitive agreements between brand name and generic drug manufacturers
that limit, delay, or otherwise prevent competition from generic drugs; and
(2) to support the purpose and intent of antitrust law by prohibiting anticompetitive
practices in the pharmaceutical industry that harm consumers

17. Importation: To Legalize or Not to Legalize?
Drug Importation is already legal
• FDA says 40% finished products imported, 80% APIs
• PharmacyChecker research: Top 100 brand drugs from 2015 data
• 71 imported
The real question is: Can we import lower-cost medications; the prices charged
to wholesalers and patients in Canada and other countries?
• Personal drug importation is effectively de-criminalized for individual
patients
• Tens of millions of people have already imported prescription medication to
fill prescriptions
• Buying in Canada, Mexico and during foreign travel
• Self-insured municipalities, groups and companies
• International online pharmacies

18. Importation Legislation
Affordable and Safe Prescription Drug Importation Act of 2017 (S. 469, H.R. 1245)
• Senate sponsor: Senator Bernie Sanders (VT)
• House sponsor: Representative Elijah Cummings (MD)
Safe and Affordable Drugs from Canada Act of 2017 (S. 92/64; H.R. 1480)
• Senate sponsor: Senator John McCain (AZ)
• House sponsor: Representative Chellie Pingree (ME)
The Personal Drug Importation Fairness Act of 2017 (H.R. 934)
• House sponsor: Representative Keith Ellison (MN)

19. Trump’s Limited Importation Idea
Trump administration to explore drug imports
to counter price hikes
The administration move is "a step in the
right direction toward accepting the fact
that we are very capable of importing
lower-cost safe and effective medicines."
Big Pharma Cozies Up to Trump as He Moves to
Lower Drug Prices
“Allowing lower-cost foreign versions to
fight price gouging is a great idea — but it’s
too limited in scope…FDA-approved
medicines are available at much lower cost
in Canada and the UK, for example, so
clearly Americans should be allowed to
import them for personal use, as long as
they do so from licensed pharmacies.”

20. Practical Savings Strategies
• Compare prices at your local pharmacies for low-priced generics
• Prescription discount cards
• Check price outside of your insurance
• Patient assistance programs
• Pharmaceutical company co-pay coupons
• Compare drug prices internationally on PharmacyChecker.com

21. In the “Doughnut Hole”
1. Discount cards
2. Manufacturer coupons
3. Shop around at your local pharmacies
4. Talk to your providers!
5. Government programs
6. Verified international online pharmacies

22. Online Resources
•GoodRx: U.S. Drug Price Comparisons and Coupons
•NeedyMeds: Patient Assistance and other
Programs
•PharmacyChecker: Verified international online
pharmacies and price comparisons

24. How to bring about reform to lower drug prices
• Get organized along bipartisan lines
• Lobby elected officials
• Political shaming
• Political action

25. Advocacy Groups on Drug Prices
Groups with long, respected histories that have advocated for legislative and regulatory
reforms to lower drug prices:
• Public Citizen
• Families USA
• Consumers Union
Other groups active in this area are:
• Social Security Works
• Alliance for Retired Americans
• American Federation of Teachers
New groups dedicated entirely to the issue of drug prices:
• Patients for Affordable Drugs
• Prescription Justice

27. Stronger Political Engagement
• Much more forceful, strategic and consistent action is required
• Make it a bipartisan effort
• Get politicians and political candidates on the record and hold
them accountable
• Make drug price advocacy a more prominent union issue

28. Questions and Next Steps!
Gabriel Levitt
PharmacyChecker, President & Co-founder
Prescription Justice, Founder
gabriel.levitt@pharmacychecker.com