If members of the House Energy and Commerce Subcommittee on Health had any question about whose responsibility it was on Capitol Hill to tackle how to rein in the soaring prices of prescription drugs, Rep. Greg Walden, R-Ore., set them straight.
"That is the job of this committee," declared Walden, who leads the full Energy and Commerce panel.
A handful of the health subcommittee members had suggested Dec. 13 during a three-hour hearing that a special "rump" or "splinter" group was needed to take on drug pricing — an issue that has been discussed from time to time on Capitol Hill over the past few years, but with no major actions taken.
"It would be nice maybe to have a workgroup at some point in time to work with all our participants and patient groups [discussing] what are some of the best solutions because I don't think there's a silver bullet here," said Rep. Kurt Schrader, D-Ore. "It's going to require everyone to get in the boat together."
But Walden told Schrader and other members of the health subcommittee who made similar suggestions of forming a separate group to "put a nail in that coffin," and to consider themselves already on such a team.
"This is where we're going to do regular order, right here," Walden said. "This is the splinter group."
Rep. Michael Burgess, the health subcommittee's chairman, added: "This is, indeed, the smoke-filled room."
Rep. Anna Eshoo, D-Calif., said: "It's important that the work not only begin here, but the members are responsible for shaping policy around what we are discussing, which is so important."
The subcommittee heard from an unusually large number of witnesses — a panel of 10 people from various segments of the biopharmaceutical supply chain — many of whom spent much of the three hours defending their industries or groups and pointing to the others as the cause of high drug prices.
Rep. John Shimkus complained there were too many witnesses to be squeezed into one hearing, arguing that some of the testimony would "get lost in the shuffle."
While it was a challenge having 10 people all at once at the table, Rep. Richard Hudson, R-N.C., said the exchange was helpful for lawmakers. The panel included representatives from the brand-name pharmaceutical, biotechnology, generic drug, healthcare insurance, pharmacy benefits manager, community pharmacy, hospital and wholesale distributor sectors, plus doctor and patient groups.
Many of the witnesses had appeared before the subcommittee at other recent hearings or sessions convened on the Senate side of the Capitol, reiterating many of the same arguments and recommendations, noted Rep. Frank Pallone, D-N.J., the chief Democrat on the Energy and Commerce panel.
But Pallone said it was time for action — calling on Walden to schedule a legislative hearing as soon as Congress returns from its winter break in January to examine specific proposals to address the high prices of prescription drugs.
"Our constituents want and expect us to take concrete action to address this growing problem," Pallone said. "It is long past time for Congress to take a serious look at all solutions that will help American families to afford the medications they depend on."
Walden, however, did not elaborate on what he expected from the subcommittee, nor did he discuss any plans for pursuing legislation.
The Senate Health, Education, Labor and Pensions Committee has also been wrestling with high drug prices, but the leader of that panel, Sen. Lamar Alexander, R-Tenn., has also not pursued any legislation following a series of hearings — the last of which was held Dec. 12.
No White House action
Brett Guthrie, R-Ky., vice chairman of the House health subcommittee, said he and House Majority Leader Kevin McCarthy, R-Calif., had recently met at the White House with President Donald Trump, where the costs of prescription drugs was among the topics discussed.
"We walked away with the president wanting action on this issue. He's very focused on it," Guthrie said.
Throughout his presidential campaign, Trump had made big promises to lower the costs of medicines and to work with Congress to change the law to permit Medicare to negotiate directly with drugmakers on prices.
Leaked copies of a proposed executive order also made their way around Washington earlier this year, but Trump — who has repeatedly said drugmakers were "getting away with murder — has yet to take any actions.
Food and Drug Administration Commissioner Scott Gottlieb, however, has taken steps to speed generic competitors to the market and has vowed to take more actions on the matter.
More transparency urged
Like those who testified at the Dec. 12 Senate hearing, some of the witnesses at the House health subcommittee session called for more transparency in how drug prices are set.
"Right now, they're set in a black box," said Matt Eyles, chief operating officer for policy and regulatory affairs at America's Health Insurance Plans.
"If you remember one message this morning, it's that the entire pricing process is driven off the list price of a branded drug, solely determined by the drug company, no one else," Eyles told lawmakers.
Lori Reilly, executive vice president for policy, research and membership at the Pharmaceutical Research and Manufacturers of America, had another message for the committee members — specifically that the discounts drugmakers offer through rebates get captured by "intermediaries" like insurers and pharmacy benefit managers, or PBMs, "and don't make their way back to patients."
But Mark Merritt, president and CEO of the Pharmaceutical Care Management Association, disputed that, asserting PBMs pass along the "biggest rebates, the biggest discounts possible" to health plans and employers, leaving it up to them to use those funds to reduce premiums and patient cost-sharing.
"We don't control the prices," Merritt insisted.
Reilly argued that "the list price is not set in a vacuum," and drugmakers engage with PBMs and insurers "every day in determining the list price, and their preferences, quite honestly, matter significantly."
But Merritt said such discussions "don't ever happen" and would be antitrust violations if they did.
PBMs and health plans have "zero input into that," he said.