Alarmed by a new Centers for Medicare and Medicaid Services (CMS) pilot program that aims to bring down the cost of drugs to patients, lawmakers on both sides of the aisle have lined up against it, citing concerns ranging from rationing of care to reduction in rural patients' access to affordable providers. But a Public Citizen report released Monday shows that many of the members of Congress who opposed the pilot are also bankrolled by the pharmaceutical and health-products industry-major opponents of the proposal.
The "Pharma's Orders" study by the nonprofit watchdog group examines the contributions received by the 310 members of Congress (240 Republicans and 70 Democrats) who signed two letters, as well as by the 124 members who did not sign either. (One letter opposed the CMS Medicare Part B demonstration project; a second expressed "concerns" about it.) Signers received 82 percent more in contributions during 2016 than those who didn't sign.
"The contrast here is pretty stark and shows a case where influence is pretty clear," says Rick Claypool, a Public Citizen research director and the author of the report.
The signers received a combined total of more than $7 million from the pharmaceutical and health-products industry, with an average of $23,344 per individual. Those who didn't sign either letter got nearly $1.6 million from the industry in total, with an average of $12,789.
It's not only the signers who are top recipients of pharmaceutical money. Many lawmakers who have otherwise come out publicly against the measure have also been targeted by the industry.
Senator Ron Wyden, an Oregon Democrat, has criticized the proposal for potentially driving seniors in rural areas toward hospital treatment, which is more costly. So far this year, Wyden has received $365,441 from the pharmaceutical and health industry. Senator Chuck Grassley, an Iowa Republican who called it "an ill-conceived experiment" that amounted to human research, received $130,100. Senator Tom Carper, a Delaware Democrat who questioned why it was so large and expansive, received $226,310. And Senator Orrin Hatch, a Utah Republican and one of the plan's fiercest opponents, received a massive $693,377 from the industry.
The vast majority of the industry's contributions have gone to Republicans, but Claypool believes this case reflects the current make-up of Congress, which is 56 percent Republican. Historically, the pharmaceutical and health-products industry has tended to steer most of its congressional contributions to members of the party that effectively controls Congress.
The pilot program proposed by CMS Deputy Administrator Dr. Patrick Conway would test how changing the drug-reimbursement system affects doctors' prescribing behavior. Critics charge that the existing system incentivizes doctors to prescribe more expensive drugs.
Currently, Medicare reimburses physicians the average sale price plus 6 percent for each drug that they prescribe. The proposed measure would lower this percentage to 2.5 percent, and replace the average sales price with a flat payment of $16.80 per drug per day.
"In a way, we're trying to reduce monetary influence in this process just as we're trying to reduce it in the political process," says Claypool.
Following the volley of criticism from members of Congress, Conway told the Senate Finance Committee that CMS intends to go forward with plan, albeit with modifications.
