Sen. Tammy Baldwin talks to a constituent in Stevens Point during a meeting about prescription drug prices. (Photo courtesy of Sen. Baldwin Facebook page)
Sen. Tammy Baldwin talks to a constituent in Stevens Point during a meeting about prescription drug prices. (Photo courtesy of Sen. Baldwin Facebook page)

Baldwin seeks support for bipartisan bill to break gridlock in the Senate

Last November, when Pam Bannister went to the pharmacy to pick up two medications for her 80-year-old mother, she was prepared to pay the $15 cost for each of them, just like normal. 

But Bannister was in for a shock when the pharmacist told her she owed more than $700 for the bladder medicine prescriptions. 

“I thought ‘What? That can’t be,’ ” said Bannister, who lives in Wausau. “Why was this medication suddenly so much more expensive?”

Bannister’s experience with the drug price “donut hole” is an increasingly familiar one across Wisconsin and the U.S. She was among a group of citizens who spoke about the high cost of prescription drugs Monday at an event in Stevens Point arranged by Sen. Tammy Baldwin, a Wisconsin Democrat.

Stories like the one told by Bannister are all too common, Baldwin said. To address the struggles many face paying for prescription drugs, last year Baldwin introduced the FAIR Drug Pricing Act, one of several bills jostling for passage before members of Congress return home to campaign for re-election. 

The FAIR Drug Pricing Act would require drugmakers to provide notice and reasons for large upcoming price increases. Democrats controlling the House of Representatives passed the transparency measure in December along with a perennial priority of modifying the Medicare Part D benefit so that Medicare could use its massive purchasing power to negotiate better prices with pharmaceutical companies. Price negotiating was specifically banned by Republicans when Part D was originally passed in 2003. 

“I’ve heard story after story of Wisconsinites struggling to afford the medicine they need,” Baldwin said.    

Despite bipartisan concerns about the climbing cost of prescription drugs, Senate Majority Leader Mitch McConnell, a Kentucky Republican, has not allowed a vote on the price negotiation bill, the price transparency bill, or a bipartisan bill to limit Medicare drug price hikes to the rate of inflation . 

Baldwin expressed frustration about the lack of action on the issue, saying reducing health care costs “is a top priority” for families in Wisconsin and elsewhere in the nation. 

People “want to know why President Trump hasn’t kept his promise to lower prescription drug costs, and why Mitch McConnell isn’t allowing a vote in the Senate,” Baldwin said. “We need to take action in the Senate now.”

The bill to limit price increases to the rate of inflation was introduced last summer by  Sen. Charles Grassley, R-Iowa, and Sen. Ron Wyden, D-Oregon, and forces companies to pay a penalty if their prices increases are higher. The legislation would limit senior citizens’ out-of-pocket drug costs to $3,100 annually. 

McConnell has said he backs reducing prescription drug costs, but with his Republican caucus divided on which approach to take, he said he is unsure whether any legislation on the issue can garner enough support to pass.

During his State of the Union address, President Trump spoke in support of the Grassley-Widen bill. However, concerns remain about whether that can happen, in part because of pushback from the pharmaceutical sector. Failure to pass any bill will raise comparisons to 2018, when Democrats used the health care issue to make record-setting gains in the midterm elections.

Prescription drug prices consistently poll as a top voter concern, as many consumers say they cannot afford their medication and prices that typically increase each year. Costs had shown signs of stabilizing, but prices on hundreds of drugs rose an average of 5.8 percent in January, according to an analysis from Rx Savings Solutions. Medicare spends more than $100 billion per year on prescription drugs.

While attempts to address prescription drug costs drag on in Congress, people across Wisconsin and elsewhere continue to struggle to figure out how to pay for the medications they need to remain healthy, and in some cases, to simply survive. 

La’Mont Miller, a 43-year-old Milwaukee native, has type 1 diabetes and requires insulin to stay alive. Insulin prices have tripled during the past decade, and when Miller lost health insurance for a time three years ago, he could not afford his daily doses.

Instead, Miller said, he took insulin every third day, stretching his money but also his health. After several months of insufficient dosing, Miller said he would up at the hospital, too sick to work, and racked up further medical costs. 

Miller subsequently found another job, he said, and today he can afford regular insulin doses, thanks to his having health insurance again. But he knows others with diabetes who can’t access the drug needed to keep their illness in check. 

“There are people out there struggling, people dying because they can’t afford the medicine to keep them healthy,” Miller said. “Something has to be done about it.”

Costly medicine and health insurance adversely impacts people’s lives in other ways. For instance, Green Bay resident Molly Larson would like to marry her longtime boyfriend, but by doing so the couple would make too much money to qualify for the state’s BadgerCare health insurance program. Instead, the couple won’t wed so that Larson and her two children can retain their insurance, while her boyfriend, whose construction job doesn’t provide health insurance, will gamble that he won’t require costly medical care.

“This is just the reality of today’s world,” Larson said. “It sucks.” 

Bannister, who works as a nurse with a large insurance company, learned a hard lesson in dealing with her mother’s medications. Her mother had health insurance coverage through Medicare and Wisconsin’s SeniorCare program, Bannister said, but she didn’t realize until she was faced with the shocking $700-plus prescription bill that the cost of her mother’s medicines had exceeded the yearly limit for how much those programs pay toward prescriptions.

Because the costs of her mother’s medicines had grown, that figure was reached before year’s end, leaving her to cover the full cost of those drugs until the insurance deductible is met, an increasingly common occurrence known as the “donut hole.”  

The situation with Bannister’s mother worked out relatively well. Generic drugs were available at a combined $75 cost for the two prescriptions, far less than the more than $700 cost of the non-generic medications. 

But Bannister said she knows many prescription drug scenarios don’t have happy endings. She recently learned of the case of a 19-year-old man with a chronic autoimmune condition who lost insurance when his parents divorced, resulting in his owing more than $100,000 in medical bills. 

“There are people out there who face bankruptcy because they can’t afford their health insurance, can’t afford their medications,” Bannister said. “It’s a sad state of affairs.”