Trying to find health care coverage for the high cost of prescription medication is the hardest part of Dr. Sarah Ledger’s job as a physician at Family Medicine.
“It’s taking me away from seeing patients in my clinic, which brings up another issue of physician access in rural communities, Ledger said to Sen. Chuck Grassley during a Q&A at Henry County Health Center on Thursday, March, 21.
Patients will go without lifesaving medicine or not give themselves the proper dosage because they can’t afford it, Ledger said.
Insulin in particular costs “a few cents” to make, but patients have to pay hundreds of dollars at the pharmacy.
“They’re coming to me with high blood sugars because they’re trying to extend the life of their insulin,” Ledger said. “I would ask for your support in cutting out these PBMs (pharmacy benefit managers), and let the people have medicine they need to survive,” she said to the senator.
Grassley shared Ledger’s frustration, while also saying that high prices of insulin is a little different from other prescription medication. Insulin is a 100-year-old product, and the price continues to rise because someone invents a new way of injecting it.
“That’s where the cost comes,” Grassley said.
Grassley said he sent a letter to three pharmaceutical companies, and before he got an answer Ely Lilly and Company, a global pharmaceutical company, put out a news release announcing they would put a generic medication on the market.
“Well, why don’t they have a generic on the market in the first place? Because they wouldn’t make as much money off it, I presume,” Grassley said.
Reducing health care costs is a top priority for Grassley, he announced earlier this year. During the Q&A, Grassley said the Senate will be holding a hearing in two weeks with PBMs to “do something to bring transparency to drug pricing.”
“We’re not going to stop there,” Grassley said. “I can’t tell you where we’re headed, except why does there have to be so much secrecy in pricing the drugs?”
Medicare was another topic of conversation during the Q&A. Grassley said nothing will get done until Republicans and Democrats brainstorm together and a president is willing to sign what they come up with. Getting Republicans and Democrats to work cooperatively on entitlements is “always difficult” because it requires tough decisions, he said.
“We happen to have a president who says we don’t need to do anything about Medicare and Social Security. I disagree with that 100 percent,” Grassley said. “We ought to be working yesterday because it’s easier yesterday than it is tomorrow. We just got to sit down and do it.”
Matt Winsel, with Great River Health Systems, said that they are facing a budget loss of $26 million and operating at a negative 8 percent margin this year. He asked Grassley what the likelihood was of a new bill REACH — Rural Emergency Acute Care Hospital Act — being approved.
REACH would allow rural hospitals to give up their residential beds for a special Medicare reimbursement. Grassley said residential beds, which make up about 4 percent of beds in Iowa, are expensive areas for hospitals to maintain. Grassley said REACH would be voluntary for rural hospitals, and could possibly maintain rural hospitals that wouldn’t otherwise be maintained.
Grassley said this is a part of looking at quality over quantity. The bill needs to be rewritten some, and Grassley said he hopes to have it put together for this fall.
Steering away from health care, Grassley also addressed concerns over lack of workers in southeastern Iowa, and whether immigration laws could allow unskilled workers in to help fill jobs.
Grassley said the problem with bills that would let immigrants to fill unskilled labor positions is they can be amended.
“People on the left would amend it saying we’re going to legalize the people undocumented right now. People on the right think you can load up all 10 million (undocumented) people and get them out of the country. Neither one of them are realistic. That’s what keeps us from bringing it up,” Grassley said.
Grassley said bills addressing unskilled workers need “integrity” put into it like E-Verify, a web-based system that allows enrolled employers to confirm the eligibility of their employees to work in the U.S.
to work in the U.S.