Height Securities: The Clock Is Ticking For Big Pharma As Congressional Spending Cuts Loom

The pharmaceutical industry is lobbying to reverse part of the recent Congressional spending bill that shifted a $10-billion consumer aid burden from the federal government to manufacturers.

The Bipartisan Budget Act of 2018 accelerated the closure of the Medicare Part D coverage gap from 2020 to 2019, lowered plan sponsors’ costs from 25 percent to 5 percent and increased drug manufacturer discount requirements from 50 percent to 70 percent.

Height Securities expects the industry has until March 23 to roll back the changes, considering the next government spending bill is the only legislation relevant to health care that Congress is guaranteed to consider this year.

Collateral Damage

Height anticipates that the reconsideration of the coverage gap solution will inspire a revisit of other drug pricing policy. 

“In our view, when it comes to the drug pricing debate, Congress and the administration have shown an interest in bringing down out-of-pocket costs for consumers and not in directly lowering list prices or reducing overall drug expenditure,” analyst Andrea Harris said in a Monday note. “Therefore, Congress's attempts to reduce OOP drug spending are likely to impact managed care companies, pharmacy benefit managers and/or pharmacies.”

Harris said she expects exploration of an out-of-pocket maximum for Medicare Part D or the alteration of pharmacy benefit manager rebate and pharmacy price concession requirements.

“While we think the proposal's $42-billion cost makes it unlikely that [the latter] will be included in the spending bill, we do see robust Congressional support for the part of the proposal that would require pharmacy price concessions to be reflected in beneficiary cost sharing at the point of sale." 

At the time of publication, SPDR S&P Biotech (ETF) XBI and Health Care SPDT (ETF) XLV were trading marginally higher at $93.13 and $86.41, respectively.

Related Links:

3 Likely Health Care Disruptors In 2018

Height: Congressional Budget Deal A Boon For Private Prisons