Competition in the Prescription Drug Market

Show Notes

To stop significant increases in drug pricing, greater competition is needed in the drug manufacturing industry. To analyze the role public policy plays in this challenge, host JC Scott talks with Lauren Aronson, health policy expert and Executive Director of the Campaign for Sustainable Rx Drug Pricing (CSRxP). Lauren shares the defining moment that started CSRxP, the main challenges policy experts face in rising drug prices, examples of manufacturers’ unsustainable pricing methods including their patent shenanigans, and potential solutions in creating sustainable methods for affordable drug pricing. They also talk about the current landscape in Congress and the Administration when it comes to political strategies to lower drug costs. 

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JC Scott, President & CEO of the Pharmaceutical Care Management Association, discusses the latest trends, public policy developments, and political challenges impacting drug pricing and healthcare.

You'll hear the nation's top thought leaders, policy experts, and political analysts on topics like how employers, unions, and others use Pharmacy Benefit Managers (PBMs) to drive value for their members in the face of growing healthcare costs. You'll also learn about advancements in gene therapy, biologics, other cutting edge therapies, and the patient benefits and cost challenges that come with them.

The Pharmacy Benefit will also analyze the latest news from inside the industry and give you an educated perspective on where things currently stand and where we think they're headed.

JC Scott (00:08):
Welcome to The Pharmacy Benefit, a podcast that highlights the role of PBMs in serving millions of patients and consumers throughout the country. I'm JC Scott. On this episode, we're going to talk about the outlook for public policy on drug pricing, the politics involved, and a set of ideas being looked at by Congress, the Biden Administration, and many other stakeholders to inject greater competition into the drug manufacturer marketplace.

JC Scott (00:32):
Joining me in this conversation is Lauren Aronson. Lauren is a health policy expert and serves as Executive Director of the Campaign for Sustainable Prescription Drug Pricing. This organization is a broad-based coalition of stakeholders, physicians, nurses, hospitals, consumers, health plans, PBMs, pharmacists, and businesses promoting bipartisan, market-based solutions to lower drug prices in America.

JC Scott (00:55):
In addition, Lauren is also a partner at the consulting firm of Mehlman Castagnetti Rosen & Thomas. Prior to her tenure at the firm, Lauren served in several high level government positions, including at CMS and in the Obama White House. Lauren was a key member of the Obama Administration's team that worked to enact the Affordable Care Act. Lauren also served as Health Policy Advisor to then US Representative, Rahm Emanuel. Lauren, thanks for being here and welcome to The Pharmacy Benefit.

Lauren Aronson (01:23):
Great. Thank you, JC. It's great to be with you today.

JC Scott (01:26):
So let's start out with a little bit of a level set and tell everyone about the work that you're doing at the Campaign for Sustainable Prescription Drug Pricing. And full disclosure for our listeners, PCMA is a member of the coalition. But tell everybody, what is the objective of the organization?

Lauren Aronson (01:40):
It's great to be with you again, JC. Our campaign started in 2014, largely as a response to Sovaldi. So particularly, as I'm sure we'll get into, but you think about the new Alzheimer's drug that just came to market and what that means for consumers and for payers.

Lauren Aronson (01:54):
This is one of those defining moments. And so it brings me back actually to how CSRxP first began in 2014. And it really was a response to Sovaldi. You had Sovaldi hit the market and many consumers and physicians, and hospitals and payers were greatly concerned about the price tag associated with that drug.

Lauren Aronson (02:12):
And so what we're working to do and we've grown and done over the last several years is really just to level set the conversation, talk about what manufacturers are doing, where we need to bring down prices, and how we hold manufacturers accountable for their egregious practices.

Lauren Aronson (02:25):
So as you noted, our campaign is very broad and diverse. But what really unites our members is this focus on prescription drugs, bringing down prices and holding manufacturers accountable.

JC Scott (02:36):
That's great Lauren. Obviously, a very important and timely mission that the organization is pursuing. And you alluded to the issue area, the problem that you're seeking to address, and maybe it will be helpful to talk a little bit about the problem definition that we're seeing when it comes to drug pricing.

JC Scott (02:50):
And there was a hearing just a few weeks ago at the House Committee on Oversight and reform on drug manufacturing, pricing strategies. So maybe talk a little bit about the takeaways from that hearing. Does that dovetail with your view on what you see as the problem that the campaign is trying to solve?

Lauren Aronson (03:06):
It's a great question, JC. So the way I think about the drug pricing challenges here are threefold, because obviously the problem is so diverse. And I think, especially when you're talking to policymakers, it's hard for members and thought leaders to get a sense of what the problem really is, because there are so many problems here to try to address. So I think about it in three basic buckets.

Lauren Aronson (03:25):
One are new drugs coming to market that just have significant price tags associated with them. Sovaldi was one we saw in 2014. Aduhelm is one we just saw recently that hit the market for Alzheimer's. But just generally, when you think about the outcry with drugs that are coming to market, and back in 1989, we had a situation where a drug came to market with a price tag of $8,000 a year, and that had enormous public outcry.

Lauren Aronson (03:50):
And so you think about where we are now, where you have Aduhelm, which is $56,000, little to no clinical benefits. And you also have drugs that are coming to market that are millions of dollars a year. And so that is just simply unsustainable. So when I think about the challenges we're facing, one is new drugs coming to market, which of course, we all want new innovative drugs. But new, innovative drugs are not going to help consumers if they're not affordable. That's one major challenge.

Lauren Aronson (04:15):
I'd say a second challenge are drugs that have gone up. Their prices have gone up for no rhyme or reason. So you think about Epinephrine, or the EpiPen. You think about Insulin. We have drugs that have been in the market that haven't had any clear new benefits, but are obviously beneficial broadly. But we are seeing significant price increase associated. And that's compounding. And so if you think about, if you're a consumer or a payer, a plan, a hospital, you can't budget for these significant increases multiple times a year.

Lauren Aronson (04:43):
The third bucket I think is what I consider to be the "less sexy" of drug pricing conversations, but these are drugs that are on the market, but are routinely seeing multiple increases a year. So anywhere from 2% to 9%. But when it's happening several times a year over the course of many years, and again, no additional clinical benefit here, that just has a compounding effect on the system. And so the problems we're facing are multifaceted.

Lauren Aronson (05:07):
And as we're thinking about ways to address these issues, we need to think about them differently, depending on what kind of problem we're trying to solve. But back to where you started, I think it's phenomenal that the Oversight Committee did a hearing on these issues and particularly, had the CEO of the AbbVie testify. When I think about the challenges we're facing, from a drug pricing perspective, Humira is the poster child for all of these problems.

Lauren Aronson (05:29):
Humira is an example where the drug came to market in 2002, exclusivity has expired. We should have a biosimilar on the market. We do not because of patent shenanigans or patent thickets, which I'm sure we'll get into in a second. We also have significant prices increases happening year after year, after year. And so it really encompasses all of the challenges we are facing.

Lauren Aronson (05:50):
So I thought that the Oversight Committee's work that they did, really to try to dig in on AbbVie's egregious practices here, was really impactful and helpful. At the hearing itself, we also had a number of academics and thought leaders who do a lot in the patent space, really talk about the challenges. And so I think it was really helpful for thought leaders to unpack these problems and really have an airing of the challenges we're facing.

JC Scott (06:12):
That's a great overview, Lauren. And you're right. What I heard at that hearing was some focus on the system that we have that protects intellectual property. And what you're describing, see to me, on a very basic level, I assume market forces eventually are going to come into play and that's going to work.

JC Scott (06:26):
We're going to pay for the value of the drug. There's going to be competition that forces prices downward. That's our system. That should be sufficient to help us make sure that we're balancing rewarding innovation and providing affordable access.

JC Scott (06:40):
But I think what we heard at the hearing is that that's not fully working. Can you talk a little bit more specifically about that system of protection for intellectual property, patents, the exclusivity system, and why it may not be functioning as well as it could be when it comes to prescription drugs?

Lauren Aronson (06:55):
I think you hit the nail on the head, JC. The market only works when we have competition. And so that's why we've seen in the generic space, a ton of competition here. And so that's why generic prices are kept low, because you have significant competition.

Lauren Aronson (07:08):
But as it comes to these more expensive drugs, on the brand biologic side, we've just had a pathway for biosimilars put into effect in 2010, but we're not getting biosimilars to market for a few reasons. And this plays into all of the issues you just highlighted.

Lauren Aronson (07:24):
One, we need to get biosimilars to market and that is very challenging to get through the FDA approval process first. But getting biosimilars to market and having that competition with brand biologic drugs, which are so expensive, is a big challenge right now, particularly because of the intellectual property shenanigans that a lot of manufacturers are implementing.

Lauren Aronson (07:41):
And they openly talk about this as a way to protect their market share. And so one of the biggest challenges we're seeing is that you're seeing not only patents being filed on the drug itself, but you're seeing hundreds of patents being filed on every little aspect of the drug itself.

Lauren Aronson (07:59):
So going back to Humira for a second, there are over 300 different patents that have been filed on Humira. It is one drug, it is one drug. It has not changed. It is the same and has been for many, many years. So the question is, why are there over 300 patents filed on that drug?

Lauren Aronson (08:16):
And so for any manufacturer that wants to come in and try to create a biosimilar for it, you have to then litigate every single patent. That takes years and millions of dollars. And so that is one of the biggest reasons why we don't have more competition in the space. It's because of patent litigation and all of the patent thickets that manufacturers are utilizing to protect their market share.

JC Scott (08:40):
You used the word shenanigans, as you talked about the intent behind the use of these patents and exclusivity periods as being protecting market share. Shenanigans is a technical legal term, I know. There is a purpose behind the patent system. It's not just to protect market share, it's to reward innovation.

JC Scott (08:57):
And I think you mentioned the Alzheimer's drug. And for many families that have suffered from Alzheimer's, they're looking for options. My dad passed away a couple of years ago from Alzheimer's. His brother was in his early 50s when he passed away from the disease. There's a history in the family.

JC Scott (09:12):
And the idea that we would have a drug out there that starts to get at the theory of addressing the amyloid plaque in the brain, that's pretty exciting for the future of science. So we want to reward innovation, but it seems like the system that's designed to reward innovation, it's gotten a little off course. Is that what you're saying?

Lauren Aronson (09:29):
I absolutely agree. We definitely want new innovative therapies to come to market and we want to make sure that they're accessible. But we also need to make sure they're affordable, too. And so that is one of the things that is truly a balance.

Lauren Aronson (09:43):
One thing that's very interesting about the Alzheimer's drug is that the label itself is just so broad. My understanding from all of the work that was done on the drug itself is that it showed some potential clinical benefit, particularly for folks who are much younger. And so I think that there is something to be said for, is it an experimental, particularly for populations that are younger?

Lauren Aronson (10:05):
I certainly firmly believe and recognize we want to make sure we have access to these drugs. But along the way, there are some serious problems that came across with the FDA approval and the price itself. And that is a really big challenge here.

JC Scott (10:20):
I feel like you and I could have a second conversation at a future date about the FDA accelerated approval process, this particular drug, how you balance access and innovation. There's a road we could go down, but I want to stay focused on the fundamentals here a little bit.

JC Scott (10:33):
And going back to the shenanigans, if you will, you alluded to a couple of specific practices that I think are good examples of the problems that we're seeing within the system. And for our listeners, could you describe these a little bit? You mentioned patent thickets as one area. What is a patent thicket? Help us understand that.

Lauren Aronson (10:51):
Sure. And so a patent thicket is basically a protective measure where manufacturers will file patents on every sort of aspect, not only on the drug itself, but the manufacturing of it, to create truly a thicket around the drug itself. So if anyone were to try to challenge one of those patents, as you challenge one, there's another 10 or 15 behind it. And so it's really that sort of force.

Lauren Aronson (11:13):
So the patent protection could take on many different forms, but what we're seeing are patents being filed on very small aspects. Not the whole drug itself, but either the manufacturing, or it could be on the coloring. It could be on the dosing. So there are a variety of ways that manufacturers are trying to just, again, protect their market share, by having all these patents filed on the drug to prevent competition.

JC Scott (11:39):
Is that the same thing as product hopping? Or is that a different practice?

Lauren Aronson (11:43):
It's a little bit different. Product hopping though, is slightly different. And that what you're saying for product hopping is that as an exclusivity is getting set to expire, a manufacturer then may change what the dosing is, or may go to an extended release.

Lauren Aronson (11:57):
And then they'll take the other drug off market and say, "No, only this new version," which may be a different color, "is going to be on the market." So they're restarting the exclusivity clock by having potentially, changes to the drug itself.

JC Scott (12:12):
So from a time period perspective, as you look at those two examples, what does that mean in terms of how long a manufacturer might be able to maintain protection and exclusivity?

Lauren Aronson (12:21):
Unfortunately, I would love to say there's a time period associated with it, but sky's the limit here. Depending on how creative manufacturers are, they can continue to make modifications to drugs, again with no clinical additional benefit, or file additional patents just to continue to protect their market share, and prevent either generics or biosimilars from coming to market and having lower cost alternatives for consumers.

JC Scott (12:43):
That's super helpful, Lauren. So looking ahead then, we talked a little bit about what that means for innovation, what that means for patients. Because from the patient perspective, you're balancing the cost impact of having drugs that can be priced wherever the manufacturer wants to price them, but also trying to balance the reward for innovation when a breakthrough new therapy is designed.

JC Scott (13:04):
So as policymakers look at trying to strike that balance and maybe addressing some of those areas, is there a legislation that you're watching that you think has got a chance here of moving forward?

Lauren Aronson (13:15):
There have been a number of bills that have been introduced in Congress to try to address all of these challenges. In 2019, the Finance Committee had a number of hearings with CEOs. And what was most interesting to me at that point was actually Senator Cornyn from Texas, who really harped on the CEO of AbbVie at the time, and the patents around Humira.

Lauren Aronson (13:35):
And so Senator Cornyn, along with some other senators on the Democratic side of the aisle, have been working on bills to try to address these patent issues. But of course, they're challenging because when you're talking about patents, it obviously can go much broader than just beyond prescription drugs. And that of course, is a challenging dynamic.

Lauren Aronson (13:52):
But there have been a number of bills introduced in Congress to try to deal with some of these issues. And it's been pleasant to see a lot of them done on a bipartisan basis. I think the other thing that's a challenge as well, again as we're trying to address issues around drug pricing is, how do you ensure that you're holding manufacturers accountable for their price increases?

Lauren Aronson (14:11):
How do you hold them accountable for just their egregious practices in general, whether it be product hopping or patent thickets? But then also making sure that when we are doing this, we're doing it in a way that's actually not going to then all of a sudden have a balloon scenario where if you're squeezing here, then prices are increasing over here.

Lauren Aronson (14:28):
And that's a little bit of a challenge to make sure that we're putting downward pressure, and also making sure that they realize that we have to be in a different situation where sky is no longer the limit in terms of what they can do for prices.

JC Scott (14:40):
So, what does that mean in practical terms, when you think about what can be done from a public policy perspective? Does that mean rather than one-off rifle shot bills, we need a more comprehensive package of drug solutions to avoid that balloon effect?

JC Scott (14:53):
And honestly, given the history we've all lived through the last many years about Congress trying to address drug pricing, how realistic is it that they can get it done this time around?

Lauren Aronson (15:02):
So I'm an eternal optimist, despite being a cynic from New York City, but I do think that we are in a situation now where the challenges that consumers are facing, and us as payers or the government taxpayers, is so challenging that I think there's bipartisan acknowledgement that this issue needs to be addressed.

Lauren Aronson (15:20):
And I think the challenge though, is figuring out ways that you can ensure that we are maintaining access to drugs, that we're maintaining innovation. But again, it's not a false premise. We can have innovation and have affordability. It's really a challenge for the manufacturers. Are they going to come to the table and actually engage in a real conversation?

Lauren Aronson (15:39):
That's not just moving the needle a little bit and having others in the system pick up additional costs. Right now, manufacturers aren't taking on any responsibility at all for their practices. And they always talk about research and development, and research and development is absolutely critical.

Lauren Aronson (15:53):
But we also know that they spend more on marketing and advertising than they do on research and development. So we need to have a conversation about that as well. I say broadly though, I think policymakers, the president, members of Congress on both sides of the aisle, very much recognize that this is the moment. We are in a situation where the current path is just unsustainable.

Lauren Aronson (16:13):
So I think we're going to see, and we have seen a lot of interest in working on this issue in Congress. Most notably right now, there's work happening on the House side on H.R.3, which we can certainly talk about. I'm sure, JC, you have lots of strong opinions about that bill as well. And over on the Senate side, there's a process underway with Senator Wyden and others, about how do you address these issues?

Lauren Aronson (16:33):
But again, the challenge is thinking about one, particularly for consumers, you want to make sure that they are paying low costs at the pharmacy counter. But we also want to make sure though, that we're not somehow increasing Medicare premiums. So thinking for a moment about the misguided rebate rule that the previous administration put forward, in my opinion, I think you shared this JC, is it really was a misguided opportunity.

Lauren Aronson (16:59):
When you're walking away and all of a sudden you're going to have significant premium increases for Medicare beneficiaries who are on fixed incomes, you're going to increase cost to taxpayers, and the manufacturers are going to walk away with a windfall, then something is wrong here.

Lauren Aronson (17:14):
And so we want to make sure those are low in cost at the pharmacy counter, while also not accidentally increasing Medicare premiums, or premiums for others in the commercial market. And so again, if we're just moving numbers around, that's not going to actually do anything. We need to make sure that manufacturers have skin in the game. And that's one of the things that I think Congress is really focusing on right now.

JC Scott (17:34):
It would not be The Pharmacy Benefit Podcast without a mention of the rebate rule. So, thank you for getting that in, Lauren. And I will fully agree with everything you said around that issue. I want to press you a little bit.

JC Scott (17:44):
You talked about the big picture dynamics there, as we think about solutions. But from CSRxP's standpoint, what are the top three or four must-haves in terms of drug pricing policy? Maybe get a little bit more specific about what needs to be in a package, from your perspective.

Lauren Aronson (18:00):
One thing that's always challenging when you're thinking about this is we don't want to be myopic. I think we don't want perfect to be the enemy of good. And this is such a challenging dynamic that any time Congress is willing to work on this issue and try to address it one challenge at a time, we think it's important.

Lauren Aronson (18:13):
So just thinking back a few years now, to the CREATES Act, it was something we spent a lot of time on many years ago, which was, again, we had a situation where manufacturers were really trying to hide behind one small FDA process to prevent generics from getting access to samples, to do bioequivalence testing.

Lauren Aronson (18:29):
And that was really impacting a generic version of a drug from coming to market. So the CREATES Act was something we worked on for a long time, but that ultimately became lost. We stopped one of those abuses. And it is a little bit like whack-a-mole. There are multiple different ways that manufacturers try to abuse the system, and we need to figure out a way to deal with all of them.

Lauren Aronson (18:47):
There are approaches. You could do it in a comprehensive manner, but there are also ways you can do it in a more skillful manner, too. I'd say we also had a lot of success as well, going through the trade conversations with USMCA last Congress, where the brand name manufacturers had a lot of things they wanted to accomplish to protect their market share.

Lauren Aronson (19:06):
And ultimately, we prevailed. And there weren't additional protections put in place in those trade bills for them, which was huge. So as we're moving forward again, we don't want perfect to be enemy of the good. But I think as I define success, I'd say it's a couple of things. One, I think that obviously, the fact that Medicare beneficiaries right now, there's no out-of-pocket cap is a challenge.

Lauren Aronson (19:29):
So we want to make sure that we are protecting Medicare beneficiaries. At the same time though, we want to make sure that manufacturers are paying their fair share for this. Because the reason why Medicare beneficiaries need a cap on out-of-pocket costs is because costs are so high.

Lauren Aronson (19:44):
So we want to ensure that if we're going to redesign the Medicare Part D program, which absolutely needs to be modified and updated, we need to ensure though that manufacturers have significant liability here to help cover some of these costs. That is one thing that we feel very, very strongly about.

JC Scott (20:02):
And to jump in on your number one, the point you're making in part is there are some consumers, some beneficiaries in Part D that do have exposure to high out-of-pocket cost. We need to address that.

JC Scott (20:12):
But if we only address that without bringing prices down, then we're just shifting costs around in the system and not getting at the root problem. It all has to be done together, right?

Lauren Aronson (20:20):
Absolutely. I think the other element that's really important also, is getting more generics and also biosimilars to market. And we've talked a lot about this already. But as we're thinking about what the trajectory is of drugs, and new drugs coming to market, many are brand biologics.

Lauren Aronson (20:36):
And so my wishlist would be for the level of exclusivity for biologics to go down from 14 years to seven. That is something that President Obama talked about for a long. That is something that our coalition has talked about for a long time. That is unlikely at the moment to be honest, but that is something long-term, would have a significant impact on it.

Lauren Aronson (20:55):
But any policy that would help get more biosimilars to market, whether it's dealing with patent issues or other reimbursement issues, we think would be really, really positive. And then I'd say third, we have a number of drugs that are really just outpacing inflation.

Lauren Aronson (21:10):
And so we need to think creatively about, how do we ensure that we are keeping that downward pressure again, on prices? That way it's not just going up year after year, after year, and multiple percentages each year. And then I'd say finally, this is not as impactful from a pricing perspective, but really important is transparency.

Lauren Aronson (21:29):
And the transparency on the part of the manufacturer is really a challenge. We know a little bit about how they determine the price of their product, and what we've learned so far is that sky's the limit. There's no formula, there's no rhyme or reason. Going back to work that Senator Wyden and Grassley did in 2016 on Sovaldi, again they determine the price of the product based on what they thought the market would bear.

Lauren Aronson (21:52):
And it doesn't have any direct costs or any direct association with research and development. So we need to have an honest conversation about how manufacturers are determining the price of their product. What are the inputs? How much are they truly spending on research and development, the significant cost they're spending on marketing and advertising?

Lauren Aronson (22:09):
Perhaps if they spent less on marketing and advertising, we can have lower prices. That's a conversation that we feel truly, we need to have about, again, the transparency part for manufacturers is really a black box. And we want to know more about how they determined these prices.

JC Scott (22:24):
And the end goal of that transparency is obviously that we want the system to reward the value of the therapy, the innovation, the drug. And without sufficient information to really measure or engage that value, it's hard to make sure the system's getting it right.

Lauren Aronson (22:39):
Absolutely. And particularly when a new drug is coming to market, when drugs are coming to market in the EU, they have to provide a dossier of what the clinical benefit is for that drug. If there's a drug that's going to have significant clinical benefit, well then maybe a high price is appropriate. But the reality is we don't have that information now.

Lauren Aronson (22:58):
And so that is really a challenge for us as a system and as a country to grapple with. We all want new, innovative drugs to come to market, but we also need to make sure that they are one, actually offering additional clinical benefit, but also affordable. Because again, a new, innovative drug that comes to market with a huge price tag that's unaffordable, does nothing for anyone.

JC Scott (23:16):
And just dovetailing off that a little bit, for years, we all in the healthcare system have talked about moving to a system that rewards value, value-based care, value-based purchasing.

JC Scott (23:25):
And then the drug space in particular, many PBMs out there are trying to experiment in particular, with sole source, high cost drugs with value-based arrangements. But it feels like we never crest that hill. What's your perspective on the move to a more value-driven system?

Lauren Aronson (23:39):
It's a great question, JC. I'm a little skeptical, to be honest. I think that in certain circumstances, it could be done well, but I think everyone defines value differently. And so trying to get to the same page between what a consumer is going to define as valuable versus a manufacturer, versus a payer I think is a challenge.

Lauren Aronson (23:57):
I think there are certain circumstances though, where they are value add and will work, but they're not the panacea to solve the problem, which is what we're seeing from manufacturers. They think if we have value-based contracts, it's going to solve all problems.

Lauren Aronson (24:08):
And I personally don't believe it will. I think again, in limited certain circumstances, it can be beneficial. But again, it's really again how you define success and how you define value. And that's going to be, I think, a particular challenge moving forward.

JC Scott (24:21):
So from your perspective, it gets back to your point that it has to be a holistic solution. At the outset, you got to address the competition question. We have to address the price point as the foundation of all this.

JC Scott (24:33):
And then building off of that, we can look at things like modernizing Medicare Part D to help with those beneficiaries that may have high out-of-pocket costs. Transparency to give us more data, so that maybe in limited instances at least, hearing your skepticism, there may be a time and a place for certain value-based arrangements as a part of that big picture.

Lauren Aronson (24:51):
Absolutely. But I think one other piece on the value-based side too, is we need to have more information about what the clinical benefit of these drugs are. And we really don't have that information right now. There are very few institutions that are doing that work. ISAR is one of them. They do phenomenal work, but they're just one institution right now.

JC Scott (25:06):
Now, I'm going to ask you a final question, Lauren. And it's the kind of question that our team here doesn't always love me to ask, because it's going to date our podcast a little bit.

JC Scott (25:13):
But we are at the end of June 2021, the president and a group of senators have announced a deal on infrastructure that they want to bring before the House and the Senate. And they're looking at reconciliation as well. In the mix of things this year, what are the odds that you would put on some kind of package or drug pricing measures being enacted before the end of the year?

Lauren Aronson (25:34):
I'm going to go with 75 to 80%. I think it'll happen on a partisan basis in reconciliation. And I think that the Democratic base wants to do something on drug pricing that will help spur action in Congress. I think the speaker herself was also very committed to this.

Lauren Aronson (25:54):
President Biden is committed to it. He talked about it a lot in his address to Congress. And Leader Schumer is, too. And even Senator Wyden put out his proposals this week. So I think that there is enough of a desire on the part of Democrats to do this.

Lauren Aronson (26:06):
Is this going to be the thing that leads reconciliation? No. Reconciliation is going to be led by childcare, tax credit, and other more politically salient, easier issues to address. But that said, I believe that drug pricing is still very high on the list. And I think members of Congress are going to want to address it.

JC Scott (26:22):
You said you were an optimist, and I would say those odds feel optimistic. We'll have you back in the fourth quarter and see how it's looking at that point.

Lauren Aronson (26:28):
Sounds good. It's my pleasure. Thank you for having me.

JC Scott (26:31):
Thank you. We've really enjoyed the conversation. And thanks to all of you for listening. I encourage you to subscribe to The Pharmacy Benefit and download all of our podcast episodes. You can do that on Google Podcasts, Apple Podcasts, Spotify, or wherever you find your favorite podcast. I'm JC Scott. Thanks for joining me.