WASHINGTON – Kristine Lund spends roughly half her $2,400 monthly disability check on prescription drugs to treat a degenerating spine, chronic pain and intestinal issues. The 51-year-old former schoolteacher knows exactly what the high costs of medicines mean for Americans who cannot afford them.
"If I didn't have my boyfriend," Lund said, "I'd be homeless."
Lund is among thousands of Minnesotans U.S. Sens. Al Franken and Amy Klobuchar had in mind when they teamed with 14 other Senate Democrats to offer an "Improving Access To Affordable Prescription Drugs Act," known officially as S. 771. Franken introduced the bill March 29. (A summary is here.) A companion bill was offered in the House. They represent one of the most comprehensive efforts ever to address the prickly problem of prescription drug prices.
The bill lifts a current ban on Medicare negotiating pharmaceutical prices. It pushes generics to market faster. It quickly closes the Medicare "Doughnut Hole," where seniors must pay the entire costs of prescriptions. It allows prescription drugs to be imported from other developed countries whose safety and effectiveness testing is as good or better than the U.S.
These suggestions all seem to make sense if the goal is to bring down the cost of prescription drugs to U.S. consumers. Yet Congress, urged on by the pharmaceutical lobby, has for years ignored or defeated individual bills that provided for each piece of the new legislation.
Still, Franken says it makes sense to go for broke now. "There's been a spike in the last three years in the cost of drugs," he explained. "Prescription drugs are nearly 20 percent of the cost of health care."
With the price of four of the top 10 selling prescription drugs rising more than 100 percent in the past few years, Klobuchar said, Minnesotans, like most Americans, are feeling the pinch and telling their senators.
"Timing is everything," Klobuchar explained. "People are pissed off. We've got to use that timing. The system has not worked in terms of protecting Americans' pocketbooks when it comes to pharmaceuticals."
Experts think controlling drug prices is the kind of populist issue that cannot be ignored if it can just get to a vote. As yet no Republicans have signed on to the Senate or House bills. Now, the Republican-run Senate and House must decide whether to take up a reform that attacks drug prices on many fronts.
PhRMA, the pharmaceutical industry's powerful trade group, left no doubt where it stands.
"Taken together, this sweeping list of innovation-chilling mandates on the research-based U.S. biopharmaceutical industry would not improve coverage and access to treatments but instead hurt some of our most vulnerable patients," the trade group said in a statement to the Star Tribune
The breadth of the proposal is a mixed blessing, said Hamline University political scientist David Schultz.
"In general, the larger the scope of the bill, the more opposition you run into," he said. "They may be thinking that people in Congress are upset with enough stuff that they will consider this."
Odds of a widely cast net sweeping in support from the Trump administration and Republican legislators who recently have paid lip service to cutting drug prices is a "long shot," said Norm Ornstein, a congressional expert at the conservative American Enterprise Institute. But bringing down drug prices does eventually feed into Trump's populist agenda.
Reform "could happen if we continue to have turmoil on the health care issue," Ornstein explained. "There may be a sentiment that if they can't get [everything] done on health policy [they could] do something about drug prices. If you've got an overall bill, the individual pieces may be a little easier to do."
With the wealth and power of the pharmaceutical industry mobilized, no one can guarantee that going big is better. The industry and its surrogates have already run full-page ads in the Washington Post questioning the safety of imported drugs and saying that letting Medicare negotiate drug prices — a strategy backed by 80 percent of Americans — will cost seniors more, not less.
These ads would fall flat among Minnesotans who have seen their drug costs rise, Franken said. The bill he introduced includes safeguards for drugs imported from other countries. If Medicare negotiators cannot get sufficient concessions from pharmaceutical companies, the bill lets Medicare recipients pay lower drug prices that the Department of Veterans Affairs has already negotiated.
Pushback from the pharmaceutical industry "means they're afraid of us," Franken said. "They're going to kick up a storm."
Meanwhile, Klobuchar says "price gouging" makes the case for a systematic overhaul. Last year, she and others called for investigations into an eight-year 500 percent increase in the price of the EpiPen, a lifesaving epinephrine delivery system.
Whatever is accelerating consumer costs, government officials estimate that overall Medicare drug prices will rise 5.8 percent per year from 2015 to 2025, after rising just 2.4 percent per year from 2007 to 2013.
Lund, the former teacher, is feeling the physical pain, as well as the financial pain. She says she developed a hairline fracture last summer because she could not afford a bone-strengthening medicine. She believes bringing down prescription prices "needs to be a huge priority" for federal legislators.
"I know [drug companies] need to do research," Lund said. "But there is something here like out-and-out greed."
In Spicer, Minn., 100 miles west of the Twin Cities, 78-year-old Pearl Schroeder's $900 monthly Social Security check is approximately the same as her out-of-pocket costs for prescriptions to treat her lupus, rheumatoid arthritis and lung problems.
"I can't believe the costs of drugs has gone up so far," she said.
Schroeder was eating up her small savings account and stressing out when she met a representative from the Minnesota Board of Aging's Senior LinkAge program. The LinkAge rep helped Schroeder get a $6,000 grant from the Boehringer Ingelheim Foundation to pay for her asthma drug and a donation from Pfizer of the Lyrica she takes for arthritis. The rep then hooked Schroeder up with RX Outreach, a nonprofit pharmacy, to get a discount on her lupus drug.
Largesse saved Schroeder. Franken and Klobuchar say there are too many others like her for private philanthropy to save them all.
"That's just patchwork," Klobuchar said. "The best thing here is to get actual negotiations and actual competition and stop being held hostage by big pharma."
The challenge for Democrats, said Hamline's Schultz, will be to "create a narrative" that reaches Republican voters who can pressure their representatives to take a vote. Otherwise, the bill could be seen as a symbolic partisan tactic to embarrass Republicans.
Franken and Klobuchar insist that is not the case. But they warn of consequences for business as usual.
"Congress has not reflected where the American people are," Klobuchar said.
"Because of what Trump has said and what the American people are getting, there should be pressure on Republicans to start moving on this or it's going to be a campaign issue."