Congress needs a commission for its drug policy ideas

(Editor’s note: This article originally appeared in STAT on August 9, 2018.)

By Scott Levy

As the midterm elections loom, politicians are trotting out their stump speeches promising, among other things, to lower the cost of prescription drugs. We’ve been hearing these kinds of promises for years, with few results.

If members of Congress really want to get serious about tackling the mounting cost of medications, they need to start by doing two simple things:

  • Stop relying on drug companies for information about medication
  • Hire more policy staffers who can go head to head with big pharma

Creating a permanent commission to advise Congress on drug policy accomplishes both goals.

Instead of taking even basic steps to counteract the pharmaceutical industry and its lobbyists, Congress has made itself more vulnerable to industry predation. Over the past 25 years, Congress has repeatedly cut its own funding for staff and now lacks the staff needed for sustained oversight and sophisticated legislating.

Instead, Congress is forced to turn to outside sources, which inevitably include industry lobbyists, to help it draft and analyze legislation. Like a fox building the henhouse, drug companies act in their own self-interest, opposing real reform while feeding Congress ideas that line drug company’s pockets.

Even if Congress can’t stop drug companies — or any other businesses — from flooding it with donations, it needs to stop relying on the pharmaceutical industry for its drug policy ideas. To do this, Congress should consolidate and strengthen the legislative process by creating and maintaining a permanent advisory commission on drug policy. Comprising a dozen or so experts chosen by the nonpartisan Government Accountability Office, this commission would publicly examine the prescription drug problems facing patients, pharmacies, doctors, hospitals, pharmacy benefit managers, and even drug manufacturers themselves.

The commission would be able to contribute a comprehensive vision of drug policy that Congress, with its fragmented committee system, sorely lacks. While the House and Senate each have four committees responsible for regulating discrete aspects of the pharmaceutical industry, no one in Congress has the job of understanding how different laws interact and contribute to the generation of high prices.

By contrast, drug companies have centralized operations and understand every facet of their business and the Byzantine regulations that govern it. A drug pricing commission would let Congress break down its informational siloes and match big pharma’s global perspective.

A commission could also comment on rules proposed by the FDA, the Centers for Medicare and Medicaid Services, and other relevant government agencies. That would help Congress keep track of how its laws are implemented while protecting executive agencies from being captured by interest groups. This commission would conclude its annual deliberations with a set of recommendations in an annual report to Congress.

Unlike blue-ribbon commissions that come and go with much acclaim and few accomplishments, a permanent commission can liberate Congress from its dependence on industry expertise. Grounded in evidence, the commission’s reports would provide Congress with clear analyses and carefully constructed solutions. Instead of starting with industry proposals, Congress could instead begin the legislative process by focusing on the needs of the many, not the profits of a few.

After the past eight years of partisan squabbling over the Affordable Care Act, this may sound hopelessly naive. But it isn’t. For more than 20 years, Congress has relied on a nonpartisan commission of experts to advise it on Medicare policy: the Medicare Payment Advisory Commission (MedPAC). Its recommendations are carefully evaluated by members of Congress — Democratic and Republican alike. Indeed, its recommendations have served as the blueprint for the last decade of Medicare reforms, successfully pushing Congress to pass laws that reward the quality of care instead of the quantity of care. Similarly, at MedPAC’s urging, Congress stopped giving raises to providers who weren’t becoming more productive. Because of MedPAC, when Congress crafts Medicare policy, it isn’t beholden to industry groups for expert information and analysis.

Congress has promised to fix drug prices several times before, yet the problem has only intensified. Congress needs to cure the process before it can cut prices. A prescription drug commission is just the medicine Congress needs.

Scott Levy is a former staffer for the Senate Finance Committee and a recent graduate of Yale Law School.

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