Guest Op-Ed: We Need Health Care Reforms That Help Patients, Families

By Patrick J. Kennedy

This summer, we saw remarkable, bipartisan progress on addressing rising health care costs — an issue voters have consistently ranked as most important.

The challenge for lawmakers right now is twofold: find effective solutions that make health care more affordable for all Americans without reducing access to treatments.

While our health care system often seems like a tangled knot of misaligned incentives and bureaucracy, there are most certainly bipartisan solutions that Congress can implement to achieve this dual goal.

The issue is of particular concern for the mental health community. Millions of Americans confront mental illness each day and approximately one in six use some form of psychiatric medication. And for those battling addiction, medication can sometimes mean the difference between success and failure.

Medication is not a one-size-fits-all solution. Prescriptions must be monitored and adjusted as treatment progresses. It’s why organizations such as Mental Health America consistently oppose policies that would restrict access to new medications.

Fortunately, many practical solutions have already been explored and are waiting for a champion to take them over the finish line.

Reforms like passing on some of the rebates in Medicare Part D will realign incentives throughout the whole system to bring down prices — all while providing actual savings at the pharmacy.

The plan is simple enough — forcing insurance companies and pharmacy benefit managers (massive private “middlemen” between drug companies and insurers) to pass on drug rebates to patients at the point of sale.

For patients, passing on rebates would provide immediate relief. It is estimated that sharing a portion of rebates with diabetes patients on Medicare could save up to $20 billion over the next 10 years.

Most importantly, this plan addresses the rising cost of prescription drugs.

Currently, pharmacy benefit managers pocket rebates, claiming they spread the cost of drugs throughout premiums and other patient fees. So not only are patients not receiving the savings intended for them, but the cost of medicines are rising.

Pharmacy benefit managers and insurers are incentivized to maximize the number of rebates they can receive. And since rebates are used for the most expensive drugs, this means benefit managers are also incentivized to keep drug prices high — or steer patients toward high-priced drugs.

Both practices increase costs for families across the nation. Removing incentives would help patients find effective and affordable treatment options.

I look forward to members of Congress from both sides of the aisle addressing this problem. Rebate reform is the best place to start.

Former U.S. Rep. Patrick J. Kennedy was lead sponsor of the Mental Health Parity and Addiction Equity Act of 2008 and served on the President’s Commission on Combating Drug Addiction and the Opioid Crisis. He is co-chair of Mental Health for Us and co-author, with Stephen Fried, of A “Common Struggle: A Personal Journey through the Past and Future of Mental Illness and Addiction.”

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