Call growing louder for national prescription drug plan
-
Upload
thecanadianpress -
Category
Documents
-
view
216 -
download
0
Transcript of Call growing louder for national prescription drug plan
-
7/27/2019 Call growing louder for national prescription drug plan
1/108
I_aih
kiptai_itbadic
ZfirkiireZacb`
ybd
@idihi
Kir`-Idhr Nindad, ZfHP`faac ag Zuocb` Zacb`y & Ihkbdbstritbad@ircetad Udbversbty
-
7/27/2019 Call growing louder for national prescription drug plan
2/108
bb
Zuocbsfeh oy
790-5?7-8779
?:98 Xfe @idihbid Geheritbad ag Durses Udbads
Icc rbnfts reserveh. Da pirt ag tfbs oaam kiy oe reprahu`eh ar tridskbtteh bd
idy gark ar oy idy keids, ece`tradb` ar ke`fidb`ic, bd`cuhbdn pfata`apybdn,
re`arhbdn, ar oy idy bdgarkitbad starine ar retrbevic systek wbtfaut tfe
perkbssbad ag tfe puocbsfer.
Xfbs oaam wis prepireh oy tfe @GDU ta pravbhe bdgarkitbad ad i pirtb`ucir
tapb` ar tapb`s. Xfe vbews idh apbdbads expresseh wbtfbd ire sacecy tfase ag
tfe bdhbvbhuics ta wfak tfey ire ittrbouteh idh ha dat de`essirbcy ree`t tfe
pacb`bes ar vbews ag tfe @GDU, ar bts kekoer arnidbzitbads.
Zrale`t kidiner< Ircede ^artskid
Zrale`t teik< @irac _eb`fert, Axidi Nedbdi
Gbrst Ehbtbad, Lude ?:98
BPOD< 2>6-:-267606?-5-5
Zrbdteh idh oaudh bd @idihi oy Bkprbkerbe Zcidtinedet Zrbdtbdn
-
7/27/2019 Call growing louder for national prescription drug plan
3/108
-
7/27/2019 Call growing louder for national prescription drug plan
4/108
bv
Xfe @idihbid Geheritbad ag Durses Udbads (@GDU)
Xfe @idihbid Geheritbad ag Durses Udbad represedts `case ta ?::,::: durses
idh stuhedt durses. Aur kekoers warm bd faspbtics, cadn-terk `ire gi`bcbtbes,
`akkudbty feictf `ire, idh aur fakes. Xfe @GDU speims ta icc cevecs ag
naverdkedt, atfer feictf `ire stimefachers idh tfe puocb` ioaut evbhed`e-oiseh
pacb`y aptbads ta bkprave pitbedt `ire, warmbdn `adhbtbads idh aur puocb` feictf
`ire systek.
-
7/27/2019 Call growing louder for national prescription drug plan
5/108
I_aihk
iptai
_itbadicZfirk
iire
Zacb`ybd@idihi
Kessinegraktfe@GD
U
CbdhiPbcis
Gar aver twa he`ihes, tfe @idihbid Geheritbad ag Durses Udbads (@GDU) fisoeed ihva`itbdn gar i ditbadic pfirki`ire pcid. Daw, is tfe `asts ag pres`rbptbad
hruns `adtbdue ta rbse, puttbdn pressures ad i feictf `ire systek tfit bs icreihy
stret`feh ta tfe cbkbt, tfe @GDU bs nibdbdn sake dew iccbes. Xfere bs i nrawbdn
`adsedsus tfit pres`rbptbad hrun pacb`bes requbre regark. Ihva`ites gar regark
bd`cuhe tfe @.H. Fawe Bdstbtute (i wecc-mdawd puocb` pacb`y tfbdm tidm), tfe @idihbid
Cbge idh Feictf Bdsurid`e Issa`bitbad, pravbd`bic idh terrbtarbic naverdkedts, is wecc
is pitbedt ihva`ites grak `aist-ta-`aist. Cbme aur prekbers, tfe @GDU bs `akkbtteh
ta ti`mcbdn tfe bssue ag es`icitbdn hrun `asts, wfbce edsurbdn i``ess idh quicbty
`ire. Xfe gibcure ta `adtibd tfe `asts ag pfirki`eutb`ics bs tfreitedbdn @idihisiobcbty ta pravbhe pitbedts wbtf tfe feictf `ire tfey deeh. I ditbadic pfirki`ire
pranrik bs id urnedt prbarbty bg aur feictf `ire systek bs ta pravbhe pitbedts wbtf tfe
kehb`itbads tfey deeh.
I _aihkip ta i _itbadic Zfirki`ire Zacb`y iccs gar naverdkedts, bdsurers,
pacb`y kimers, idh pfirki`eutb`ic `akpidbes ta re`andbze tfit tfe presedt fyorbh
systek we ire usbdn ta gudh pres`rbptbad hrun pur`fises bsdt warmbdn. Is Hr.
Kir`-Idhr Nindads piper kimes `ceir, aur `urredt systek bs udgibr, bdequbtioce,
-
7/27/2019 Call growing louder for national prescription drug plan
6/108
vb
Kessine grak tfe @GDU. Cbdhi Pbcis
idh wistes kadey bd kidy hbggeredt wiys, grak ex`essbve ihkbdbstritbve gees ta
naverdkedt tix suosbhbes, ta udde`essiry idh expedsbve treitkedts. _egark bd tfe
`urredt `adtext bsdt rihb`ic= ritfer, bts tfe ritbadic, respadsboce `fab`e we deeh ta
kime.
It tfe @aud`bc ag tfe Geheritbad keetbdn bd ?::8, prekbers `akkbtteh ta tfe
`reitbad ag i ditbadic pfirki`ire pcid. ^e fih tfe prekbers ad-oairh, out tfe
geheric naverdkedt uctbkitecy gibceh ta hecbver ad bts `akkbtkedts. It tfit tbke, tfe
@GDU wis fapeguc tfit bts ihva`i`y eggarts wauch ceih ta i ditbadic pfirki`ire
pcid. Udgartuditecy, is tfbs piper pabdts aut, hespbte tfe canb` oefbdh bt, tfe ci`m ag
pacbtb`ic wbcc idh vesteh `arparite bdterests rekibd kilar stukocbdn oca`ms. Pbd`e
tfed, tfere five oeed da steps timed ta `reite i pcid. Is Attiwi `adtbdues ta
hawdcaih `asts adta tfe pravbd`es, stret`fbdn tfebr cbkbteh ouhnets eved gurtfer,expidhbdn `aaperitbad ad `ast-egge`tbve keisures cbme tfe oucm pur`fisbdn ag
pres`rbptbad hruns kimes gar naah s`ic idh puocb` pacb`y.
Bd re`edt yeirs, tfere five oeed sake ed`aurinbdn sbnds. Xfe pravbd`bic prekbers
five garkeh tfe @aud`bc ag tfe Geheritbad Feictf @ire Bddavitbad ^armbdn Nraup
idh hevecapeh id iccbid`e gar tfe oucm pur`fisbdn ag pfirki`eutb`ics. Xfese ire
naah rst steps. Fawever, wbtfaut kare extedsbve regarks, is tfe piper hetibcs, tfbs
iccbid`e bs gibcbdn ta reicbze bts patedtbic.
Obccbads bd sivbdns ire aurs gar tfe timbdn ta oe rebdvesteh bd sige, quicbty pitbedt
`ire, idh idy pacbtb`ic pirty wfb`f prapaseh ditbadic pfirki`ire wauch adcy oe
aggerbdn oetter feictf `ire ta tfe puocb`, wbtf kare kadey bd tfebr pa`mets it tfe edh
ag tfe hiy. Nbved tfbs gi`t, wfy iredt pacbtb`bids sebzbdn tfe appartudbty1 Ei`f yeir,
aur feictf `ire systek wistes obccbads oy dat kavbdn garwirh wbtf tfbs cadn prakbseh
pranrik. Kare bkpartidtcy, kbccbads ag @idihbids na wbtfaut ihequite i``ess ta
kehb`iccy requbreh kehb`itbads.
Bts dat cbme ditbadic pfirki`ire bs id udtrbeh idh udtesteh bhei. I``arhbdn
ta tfe reparts iutfar, Hr. Kir`-Idhr Nindad, @idihi bs tfe adcy AE@H `audtrywbtf udbversic puocb` feictf `ire tfit haes dat icsa five i pfirki`ire pcid. Every
hevecapeh `audtry wbtf i udbversic feictf `ire systek, ex`ept @idihi, pravbhes
udbversic `averine ag pres`rbptbad hruns, idh icc su`f `audtrbes pravbhe udbversic
`averine it cess `ast tfid @idihi.
Is tfe tbtce ag tfbs repart bdhb`ites, Hr. Nindad aggers i raihkip ta i ritbadic
hrun pacb`y sa tfit @idihi `id kave bdta tfe ?9st `edtury, icadnsbhe bts AE@H
-
7/27/2019 Call growing louder for national prescription drug plan
7/108
-
7/27/2019 Call growing louder for national prescription drug plan
8/108
vbbb
I_ai
hkip
tai
_itba
dicZf
irkiire
Zacb
ybd
@idi
hi
Garewarh
Ptev
edKarn
id,ZfH
Experts grak i`rass tfe spe`truk inree pfirki`eutb`ic pacb`y bd @idihi bsgibcbdn tfe ditbad. Ci`mbdn i stritenb` pcid gar bdtenritbdn pres`rbptbad hruns bdta
aur udbversic, puocb` feictf `ire systek, pres`rbptbad hruns ire sbkuctideauscy
udheruseh, averuseh, kbsuseh, idh averprb`eh bd @idihi.
Is Hr. Kir`-Idhr Nindad expcibds bd tfbs repart, da @idihbid pravbd`e
pravbhes hrun `averine ad pir wbtf bdterditbadic darks cet icade bdterditbadic
oest pri`tb`es. Icc pravbd`es recy ad i pit`fwarm ag prbvite idh puocb` hrun pcids
tfit aperite fbnfcy bdhepedhedtcy ag ei`f atfer idh ag tfe rest ag tfe feictf `ire
systek. Zitbedts i``ess ta puocb` hrun `averine hepedhs sbndb`idtcy ad tfebr ine,
a``upitbad idh feictf `ire deehs bd i systek tfit ceives kbccbads ag @idihbids wbtf
cbttce ar da hrun `averine it icc.
Xfe geheric naverdkedt fis timed tfe very dirraw, `adstbtutbadicbst stid`e tfit
pfirki`eutb`ic pacb`y bs, gar tfe kast pirt, sacecy i pravbd`bic respadsbobcbty. Bt aggers
da did`bic issbstid`e gar pravbd`bic hrun pcids, dar fis bt pisseh ciws tfit wauch
edsure pacb`y kimers, feictf pragessbadics, idh pitbedts five `rbtb`ic bdgarkitbad
ioaut tfe sigety, eg`i`y, idh eved tfe ivibciobcbty ag hruns ad tfe @idihbid kirmet.
-
7/27/2019 Call growing louder for national prescription drug plan
9/108
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idFeictf `ire pragessbadics idh pitbedts ire cegt wbtf cbkbteh s`bedtb` bdgarkitbad
ioaut wfb`f hruns ire oest gar tfebr pitbedts, idh s`ir`ecy idy bdhepedhedt
bdgarkitbad saur`es.
Xfe resuct< @idihi fis ade ag tfe warst pergarkbdn pfirki`eutb`ic se`tars bd
tfe warch. Hespbte tfe gi`t tfit we spedh kare ad kehb`bdes tfid icc `akpirioce
`audtrbes, cbtericcy kbccbads ag @idihbids ire udioce ta iggarh kehb`itbads pres`rboeh
oy tfebr ha`tars. Kbccbads kare oeir tfe `ast ag sbndb`idt aut-ag-pa`met expedses gar
pres`rbptbads cceh ta ihhress tfebr gikbcbes feictf `ire deehs. Idh gir taa kidy ire
firkeh oy prevedtioce aver- idh udher-use ag kehb`bdes.
Is Hr. Nindad pabdts aut, eved aur s`bedtb` `akkudbty bs sfart`fidneh. Oy
bdterditbadic stidhirhs, aur geheric naverdkedt bs dat id innressbve renucitar agkehb`bdes ar prb`es= idh, is i ditbad, @idihi spedhs kare ad kehb`bdes tfid idy
`akpirioce `audtry. Ret, tfe pfirki`eutb`ic bdhustry bdvests bd @idihi lust i gri`tbad
ag wfit tfey bdvest bd atfer `audtrbes.
Bt haesdt five ta oe tfbs wiy.
I `akprefedsbve puocb` pfirki`ire pranrik wauch bkprave tfe i``essbobcbty,
equbty, eg`bed`y, se`urbty, idh quicbty ag pres`rbptbad hrun use bd aur feictf `ire
systek. Hr. Nindad `ireguccy expcibds faw.
Udbversic `averine ag `ast-egge`tbve treitkedts bkpartidtcy, wbtfaut `a-
bdsurid`e ar hehu`tboces wauch bd`reise i``ess ta de`essiry `ire, tfereoy
bkpravbdn pitbedt feictf idh rehu`bdn hekidhs ad tfe puocb` feictf `ire systek.
I ditbadic ipprai`f ta nederb` tedherbdn idh oridh-dike prb`e denatbitbads
`akobdeh wbtf i ditbadic garkuciry wauch hrikitb`iccy cawer `asts wfbce bd`reisbdn
bdter-pravbd`bic equbty bd i``ess ta kehb`bdes. Pu`f id ipprai`f `auch icsa fecp ta
edsure tfe se`urbty ag tfe suppcy ag kehb`bdes gar @idihbids bd tfe evedt ag ncaoic
sfartines. Gbdiccy, oetter bdtenritbad ag kehb`bdes bdta tfe feictf `ire systek idh
kare i`tbve pirtb`bpitbad ag tfe geheric naverdkedt bd pfirki`eutb`ic pacb`y wauch
fecp ta bkprave tfe pres`rbobdn ippraprbitedess idh reic-warch feictf aut`akes.
Xfere bs vbrtuiccy da hawdsbhe ta i wecc-hesbndeh udbversic, puocb` pfirki`ire
systek udcess, ag `aurse, yau ire i stimefacher tfit oedets grak tfe stitus qua.
-
7/27/2019 Call growing louder for national prescription drug plan
10/108
x
Garewarh
@fiddeccbdn Zragessar _aoert Evids, Kir`-Idhr Nindad rekbdhs us tfit every haccir
ag bd`ake bd tfe feictf `ire systek bs i haccir ag sakeades bd`ake.
I``arhbdn ta Kir`-Idhr Nindads idicysbs, prbvite bdsurers, pfirki`eutb`ickidugi`turers, idh retibc pfirki`y `arparitbads five sakewfere oetweed $0
obccbad idh $99 obccbad ta case bg @idihi were ta bkpcekedt i udbversic, puocb`
pfirki`ire pranrik. Pa, eved tfaunf tfe aut`akes ag tfe stitus qua ire i ditbadic
ekoirrisskedt `astbdn @idihbids bd kadey, quicbty ag cbge, idh eved cbge btsecg
tfere ire i`tars tfit wbcc irhedtcy appase i oetter ipprai`f gar @idihi.
Out wistbdn obccbads ag haccirs every yeir it tfe expedse ag pitbedt feictf idh
wecc-oebdn `iddat oe i``epteh idy cadner. Xfe vist idh nrawbdn oahy ag evbhed`e
sukkirbzeh bd tfbs repart bs udhedbioce. @idihis puocb` feictf `ire systek sfauchdtedh is saad is i ha`tar fidhs i pitbedt i pres`rbptbad ta cc.
Xfe tbhe ag puocb` apbdbad wbcc turd is kare arnidbzitbads oe`ake bdvacveh oy
`akkudb`itbdn tfe `ise gar udbversic pfirki`ire. Is tfbs bdgarkitbad bs udherstaah,
sfireh, idh i`teh upad oy kare idh kare @idihbids, naverdkedts wbcc diccy five
tfe pacbtb`ic `aurine de`essiry ta guccc kehb`ires pres`rbptbad. ^fed pres`rbptbad
hruns ire stritenb`iccy bdtenriteh bdta aur feictf `ire systek, @idihbids wbcc edlay
oetter feictf `ire idh oetter feictf.
Pteved Karnid, ZfHHbre`tar, @edtre gar Feictf Pervb`es & Zacb`y _eseir`f
Zragessar, Udbversbty ag Orbtbsf @acukobi
-
7/27/2019 Call growing louder for national prescription drug plan
11/108
I_aihk
iptai
_itbadicZfirk
iire
Zacb`ybd@idihi
ExeutbvePukk
iry
Kir-I
dhrNindad,
ZfH
I he`ihe ina, tfe geheric naverdkedt, tfe pravbd`es idh tfe terrbtarbes iccinreeh tfere were ocitidt praoceks wbtf respe`t ta @idihbid hrun `averine.
Xfebr respadse wis tfe ihaptbad ag tfe Ditbadic Zfirki`eutb`ics Ptriteny (DZP).
Udgartuditecy, bd tfe cist ted yeirs very cbttce pranress fis oeed kihe. Xfe praoceks
rekibd i ci`m ag i``ess ta pres`rboeh hruns, tfe ci`m ag hrun `ast `adtibdkedt,
kadey wistbdn idh i grinkedteh hrun systek wfb`f keids tfit `asts sivbdns it
ade pabdt tridscite bdta `ast bd`reises ecsewfere.
Udbversic, puocb`cy gudheh pfirki`ire bs tfe hakbdidt stidhirh ikadn
kast AE@H `audtrbes. Xfe ci`m ag hrun `averine bd @idihi bs id idakicy sbd`e
kehb`itbads ire dat bdtenriteh bdta aur puocb` feictf `ire systek. @audtrbeswbtf bdtenriteh pfirki`eutb`ic `averine i`fbeve oetter i``ess ta kehb`bdes idh
nreiter did`bic prate`tbad gar tfe bcc, it sbndb`idtcy cawer `asts tfid idy @idihbid
pravbd`es i`fbeve. Fawever, bd @idihi, hrun `averine bs aggereh ad tfe oisbs ag
wfere i persad warms ar cbves, idh dat ad tfe oisbs ag fbs ar fer kehb`ic deehs.
@idihi idh tfe Udbteh Ptites, wbtf adcy iraudh ficg ag tfebr papucitbad fivbdn
i``ess ta puocb` bdsurid`e, ire autcbers wfed bt `akes ta hrun `averine. Xfese
-
7/27/2019 Call growing louder for national prescription drug plan
12/108
xbb
Exe`utbve Pukkiry
twa `audtrbes recy feivbcy ad prbvite hrun bdsurid`e, idh tfey five fbnfer avericc
expedhbtures idh spedh ku`f kare gar tfebr kehb`itbads tfid atfer AE@H `audtrbes.
Xfbs repart hekadstrites faw su`f i systek bs bdeg`bedt, bdequbtioce, wistegucidh udsustibdioce bd tfe cadn rud. Bt bs bdeg`bedt oe`iuse bt bs udioce ta ihequitecy
`aver tfe wface @idihbid papucitbad= bt bs bdequbtioce oe`iuse kidy @idihbids
piy ikaudts hbsprapartbadite ta tfebr bd`ake bd arher ta i``ess kehb`itbads= bt bs
wisteguc oe`iuse @idihbids piy taa ku`f, deehcesscy, gar pitedteh ar nederb` hruns=
idh bt bs udsustibdioce oe`iuse naverdkedts ire udioce ta `adtibd `ast bd`reises.
Xfere five oeed sake re`edt hevecapkedts wfb`f hekadstrite faw tfe iosed`e
ag i udbversic pfirki`ire pranrik i`ts is i oirrber ta pranress idh bddavitbad.
Aver tfe pist gew yeirs, nederb` hrun prb`es is i per`edtine ag tfe oridh-dike
hrun prb`es five hrappeh sbndb`idtcy bd icc pravbd`es, out tfese prb`e rehu`tbadsbd puocb` pcids were agted aggset oy i prb`e bd`reise bd prbvite pcids. Pbd`e ?::>, we
five icsa seed id bd`reise bd `adhedtbic inreekedts (Zrahu`t Cbstbdn Inreekedts
ar ZCIs) oetweed pfirki`eutb`ic `akpidbes idh pravbd`bic puocb` pcids. ^fbce
tfese inreekedts edioce sake puocb` pcids ta `adtibd hrun `asts, tfase sivbdns
resuct bd irtb`biccy bditeh `asts gar pitbedts, prbvite pcids, idh pravbd`es wbtf cess
denatbitbdn pawer. Xfe @aud`bc ag tfe Geheritbads `reitbad ag i Zid-@idihbid Zrb`bdn
Iccbid`e bd @idihi (Z@ZI) bd ?:9: (bd`cuhbdn icc pravbd`es ex`ept Yueoe`) wis
id bkpartidt rst step ta `aarhbdite idh streikcbde denatbitbads. Fawever, bt fis
cbkbtitbads sbd`e tfe `aarhbditbad pra`ess wbtfbd tfe Iccbid`e rekibds `ficcednbdn,
espe`biccy bd tfe iosed`e ag i ditbadic garkuciry. @adsequedtcy, tfbs dew Iccbid`e fis
dat oeed ioce ta reicbze bts patedtbic wbtf gew pitedteh hruns oebdn pur`fiseh idh
nederb` prb`es denatbiteh is i per`edtine ag tfe pitedteh hrun prb`e, ritfer tfid tfe
iosacute cawest prb`e tfit `auch resuct grak `akpetbtbve obhhbdn. Oucm pur`fisbdn
icsa gibcs ta edsure tfit sivbdns gar puocb` pcids de`essirbcy tridscite bdta sivbdns
gar icc @idihbids sbd`e prbvite pcids idh peapce wbtfaut bdsurid`e `adtbdue ta piy
tfebr kehb`bdes it id bd`reisbdn ag`bic prb`e, wbtfaut oedetbdn grak tfe oirnibdbdn
pawer ag tfe Iccbid`e. Hrun sfartines ire icsa bd`reisbdncy previcedt bd @idihi.
Zravbd`es idh faspbtics ire oebdn ismeh ta kidine tfe praocek ad tfebr awd wfed
sta`m sfartines ire i `akpcex ncaoic bssue deehbdn i `akprefedsbve pur`fisbdnsystek wbtf pur`fisbdn `ciuses ta ivabh sfartines. Icc tfese gi`tars pabdt ta aur
gibcure ta edsure tfe sustibdiobcbty ag aur hrun bdsurid`e systek, is wecc is tfe urnedt
deeh gar i ditbadic pfirki`ire pcid.
Xfe race ag prbvite bdsurid`e bd evacvbdn pfirki`ire pacb`y bs grequedtcy heoiteh.
Xfaunf sake hegedh bts race oy irnubdn tfit bt sives puocb` gudhs, tfe evbhed`e bs
`ceir< prbvite bdsurid`e bs pirt ag tfe praocek idh dat tfe sacutbad. Fivbdn i fyorbh
-
7/27/2019 Call growing louder for national prescription drug plan
13/108
x
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idprbvite-puocb` bdsurid`e pcid `reites i grinkedteh systek bd wfb`f tfe bdvacvekedt
ag kuctbpce piyers hbkbdbsfes tfebr pur`fisbdn pawer. Xfase gudhbdn sbcas cbkbt tfe
patedtbic gar feictf `ire kidiners idh pravbhers ta `adsbher tfe gucc oedets idh
appartudbty `asts ag pres`rbptbad hruns is id bdput bdta tfe oraiher feictf `ire
systek. Mey bssues issa`biteh wbtf prbvite pcids ire exikbdeh bd tfbs repart. Ikadn
tfe bssues bhedtbeh ire< smbkkbdn, b.e. i``eptbdn tfe naah rbsms (rb`fer, feictfber,
yaudner), idh ceivbdn tfe oih rbsms (udioce ta warm, caw-bd`ake, sedbars) ta tfe
stite= wiste (5?% bd ?:9?) ebtfer tfraunf rebkoursbdn kare expedsbve kehb`bdes wbtf
da ihhbtbadic tferipeutb` vicue, ar piybdn udde`essiry hbspedsbdn gees= geheric tix
suosbhbes (it iraudh 90%)= idh ex`essbve ihkbdbstritbve `asts.
Bd ?:9:, Xfe E`adakb` @ise gar Udbversic Zfirki`irerepart (Nindad & Foert,
?:9:) sfaweh tfit i puocb` idh udbversic hrun pcid, oiseh ad rst-haccir `averine,
wauch dat adcy bkprave i``ess ta hruns, out @idihi wauch icsa sive grak 9?% ta
8?% bd tatic pres`rbptbad hrun expedhbtures. Xfe `urredt repart uphites sake ag tfe
dhbdns grak ?:9:, idh aggers id idicysbs ag tfe `urredt pacb`y `cbkite nbved tfe ripbh
evacutbad ag pfirki`eutb`ic pacb`bes bd @idihi bd tfe pist tfree yeirs. Bt fbnfcbnfts
tfe bkpi`t ag bdhustrbic pacb`y ad pfirki`eutb`ic prb`es bd @idihi. Xfe repart
icsa exikbdes tfe nrawbdn `adsedsus ioaut tfe deeh gar pfirki`ire regark idh
sustibdiobcbty bd cbnft ag aur bd`reisbdncy udsustibdioce systek. Kare bkpartidtcy, tfbs
warm expcares wfit kust oe hade ta bkpcekedt tfe de`essiry regarks oy aggerbdn i
raihkip gar oubchbdn tfe bdstbtutbadic `ipi`btbes deeheh ta bkprave i``ess, hbkbdbsf
`asts, bkprave pri`tb`es idh edsure tfe cadnevbty ag aur feictf `ire systek.
Xfere bs id ekernbdn `adsedsus ioaut tfe de`essbty ag regarkbdn aur hrun pacb`y.
Xfe @.H. Fawe Bdstbtute, i wecc-mdawd puocb` pacb`y tfbdm tidm, fis edharseh tfe bhei
ag i puocb` idh udbversic hrun `averine pcid. Xfe @idihbid Cbge idh Feictf Bdsurid`e
Issa`bitbad fis `icceh gar urnedt hrun `averine regarks ta edsure oetter puocb` idh
prbvite `averine. Zravbd`bic naverdkedts grak `aist-ta-`aist ire nrippcbdn wbtf
tfe bssue ag `adtibdbdn `asts, wfbce edsurbdn i``ess. Idh feictf `ire arnidbzitbads
ire wbtdessbdn tfe hbre`t bkpi`t tfit hrun `asts ire fivbdn ad tfebr pitbedts feictf.
Xfere bs i nrawbdn re`andbtbad ag tfe urnedt deeh gar regark. Xfe gaccawbdn gaur
regarks agger i wiy garwirh gar pacb`y kimers
@fipter ?. Bdeg`bedt idh udsustibdioce hrun `averine
systekitb`iccy ad nederb` hruns wfb`f ire prb`eh sbndb`idtcy cawer bd tfe Udbteh
Ptites tfid bd @idihi (Gbnure 0).
Xfe gi`t tfit @idihbids piy kare gar tfebr kehb`itbads bs dat de`essirbcy id
bssue. @idihis prb`e bditbad pacb`y bs reciteh ta tfe deeh gar bddavitbad pacb`bes ta
ittri`t pfirki`eutb`ic bdvestkedts, ictfaunf tfese pacb`bes ire i `akpcete gibcure
idh, ad id idduic oisbs, very `astcy gar tixpiyers (Nindad, ?:9?`). Fawever, piybdnfbnf prb`es wauch dat oe su`f id bssue bg we, it ceist, su``eeheh bd `adtibdbdn tfe
`ast bd`reises. Udgartuditecy, @idihi giccs sfart it prb`e adtibdkedt pacb`bes. Grak
?::: ta ?:9:, tfe idduic `ast ag pres`rbptbad hruns bd`reiseh kare bd @idihi
tfid bd atfer `audtrbes wbtf i sbkbcir cevec ag e`adakb` hevecapkedt. Issessbdn
tfe `ast bd`reise `id oe i `akpcex pra`ess is tfe bd`reise `id viry i``arhbdn
ta hekanripfb` `fidnes ar hbggered`es bd bditbad rites. Bd arher ta ivabh tfese
Gbnure 0
_ecitbve retibc prb`e gar tfe sike vacuke ag pfirki`eutb`ics bd AE@H `audtrbes,
?::5 (UP$, kirmet ex`fidne rite)
:
?:
8:
7:
6:
9::
9?:
98:
97:
96:
?::
Paur`e< AE@H ?::6 - Eurastit AE@H ZZZ Zranrikke, ?::>.
-
7/27/2019 Call growing louder for national prescription drug plan
23/108
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idaosti`ces, we issesseh tfe idduic per `ipbti `ast bd`reise, usbdn pur`fisbdn pawer
pirbty (ZZZ) idh timbdn bditbad bdta i``audt.
Gbnure 8?
Reircy iverine per `ipbti nrawtf bd pres`rbptbad hrun expedhbtures, ?:::-?:9:(%, bdterditbadic `akpirbsad usbdn ZZZ)
-?
-9
:
9
?
0
8
5
@IDIHI
Lipid
Udbte
hPtites
N
erkidy
Ppibd
Iustricbi
Dew
\eicidh
Gbdcidh
Detfercidhs
AE@H
iverine
Zartunic
H
edkirm
Grid`e
Iustrbi
Pwehed
Cuxe
koaurn
Pwbtzercidh
UdbtehMbdnhak
Oecnbuk
Darwiy
B`ecidh
Bticy
Paur`e< @BFB, AE@H Feictf Hiti, ?:90
@idihis idduic iverine per `ipbti nrawtf bd pres`rbptbad hrun expedhbtures wis
tfus `adsbheriocy fbnfer tfid bd `akpirioce `audtrbes. @audtrbes wbtf cess tfid i 0%
idduic bd`reise icc five i udbversic pfirki`ire pranrik.
Zuocb` idh prbvite hrun pcids agted `ape wbtf tfese `ast bd`reises oy bd`reisbdn
tfe prekbuks ag bdsureh pitbedts, oy bd`reisbdn `a-piykedts ar hehu`tboces pibh oy
pitbedts ar oy rehu`bdn tfe dukoer ag treitkedts `avereh. Bd tfe edh, we aoserve
tfit aut-ag-pa`met expedhbtures bd pres`rbptbad hruns bd`reiseh ad iverine oy 00%
(bd `adstidt haccirs) oetweed 922> idh ?::2 (Pidkirtbd et ic., ?:98). Gurtferkare,
tfe `ast bd`reise fis oeed ku`f kare sbndb`idt gar caw bd`ake fausefachs. Bd
? Date tfit Gbnure 8 ex cuhes Nree`e idh Brecidh hue ta tfase `audtrbes pur`fisbdn pawer ritbas sbndb`idtcyigge`teh oy tfe ?::6 e`adakb` `rbses.
-
7/27/2019 Call growing louder for national prescription drug plan
24/108
2
@fipter ?. Bdeg`bedt idh udsustibdioce hrun `averine
`adstidt haccirs, oetweed 922> idh ?::2, aut ag pa`met expedhbtures gar pres`rbptbad
hruns gar tfe rb`fest ?:% five bd`reiseh oy ?9%, wfbce tfey bd`reiseh oy 78% gar tfe
paarest ?:% (Pidkirtbd et ic., ?:98).
Xa sukkirbze, @idihbids piy kare gar tfebr kehb`itbads wfed `akpireh ta
`audtrbes tfit agger i puocb` idh udbversic pcid. @idihbids i``ess ta kehb`itbads bs
dat is naah is bd atfer `audtrbes, idh tfe idduic `ast bd`reise kimes tfe @idihbid
renbke udsustibdioce bd tfe cadn rud.
I Kiy ?:90 survey gaudh tfit >6% ag @idihbids ippraveh ag tfe bhei ag i
udbversic pfirki`ire pranrik (EMAP, ?:90). Pu`f i pcid bs dat i pidi`ei idh wadt
sacve icc tfe hrun pur`fisbdn praoceks, idh `audtrbes wbtf tfbs pranrik ire icsa
gi`bdn `ficcednes bd terks ag i``ess idh `asts. Fawever, i udbversic pfirki`ire pcidwauch iccaw us ta oubch tfe bdstbtutbadic `ipi`btbes deeheh ta bkprave i``ess, rehu`e
`asts, idh edsure tfe eg`bed`y idh cadnevbty ag tfe pcid. Xfe dext se`tbad wbcc
hbs`uss re`edt hevecapkedts bd @idihbid pfirki`eutb`ic pacb`bes idh hekadstrite
faw aur grinkedteh systek bs udioce ta ihipt ta tfe hrun se`tars dew reicbtbes.
-
7/27/2019 Call growing louder for national prescription drug plan
25/108
I_aihk
iptai
_itbadicZfirk
iire
Zacb`ybd@idihi
9
@fipter 0
@idihbidpfirkieutb`ic
pacb`bes
-
7/27/2019 Call growing louder for national prescription drug plan
26/108
-
7/27/2019 Call growing louder for national prescription drug plan
27/108
-
7/27/2019 Call growing louder for national prescription drug plan
28/108
90
@fipter 0. @idihbid pfirki`eutb`ic pacb`bes. aut`akes bd i grinkedteh systek
I stuhy `adhu`teh bd A`taoer ?:99 oy tfe Gred`f kinizbde Zratnez-vaus
(Kebcceur idh Cikoert-Kbcat, ?:99) sfaweh tfit bd Yueoe` pfirki`bsts prat kirnbds
gar nederb` hruns pur`fiseh oy prbvite hrun bdsurid`e pcids rekibd extrekecy
nederaus. Xfe survey tirneteh 0?: pfirki`bes idh idicyseh tfe prb`e pibh oy
prbvite bdsurid`e hrun pcids gar nederb` versbads ag Zidtica`, Cbpbtar, Ncu`apfine,
Darvis` idh Eggexar. ^fed tfe iverine `ast prb`e (`ast ag tfe hrun + wfacesicers
kirnbd) wis $9>.>> gar tfe pfirki`bes8, tfebr iverine retibc sice prb`e wis $80.50
represedtbdn id iverine hbspedsbdn gee ag $?5.>7 idh i prat kirnbd ag 985%. Bt bs
bkpartidt ta date tfit tfe puocb` pcid adcy pibh i hbspedsbdn gee ag $6.88 gar tfe
sike prahu`ts, cess tfid i tfbrh ag wfit tfe prbvite pcids pibh.
Xfe exikpce ioave hekadstrites faw bd i grinkedteh feictf `ire systek
(puocb`/prbvite) `ast sivbdns it ade pabdt bd tfe systek `id agted tridscite bdta `astbd`reises ecsewfere bd tfe sike systek. Bd gi`t, bd su`f i `adtext, sivbdns gar sake
sbkpcy keids tridsgerrbdn `asts ta atfers. armbdn bd sbcas bs dat id eg`bedt wiy ta
stap idduic ast bd`reises.
0.?. Bd`reise bd `adhedtbic inreekedts (Zrahu`t Cbstbdn Inreekedts)
Pbd`e ?::7, we five aoserveh sbndb`idt `fidnes bd tfe ousbdess kahec
ihapteh oy pfirki`eutb`ic `akpidbes ta estiocbsf tfe prb`e ag pitedteh hruns.
^e five nade grak i tridspiredt warch wfere tfe cbsteh prb`e wis tfe prb`e pibh,ta i warch ag `adhedtbicbty idh se`ret inreekedts. Xfe reisad gar tfbs striteny
bs tfit kidy `audtrbes, bd`cuhbdn @idihi, renucite tfe prb`e ag pitedteh hruns oy
`akpirbdn tfek ta tfe ag`bic prb`es pibh ecsewfere bd tfe warch. Xa oypiss tfese
`adtrac ke`fidbsks, pfirki`eutb`ic `akpidbes daw bdite tfe sunnesteh ag`bic
bdterditbadic prb`e idh denatbite reoites wbtf hbggeredt ouyers tfraunf `adhedtbic
inreekedts. Xfe ag`bic prb`es rekibd fbnf oe`iuse ag tfe `adhedtbicbty ag tfe
denatbiteh reoites. Xfese types ag inreekedts ire tfe dew dark gar puocb` hrun
bdsurid`e pcids warchwbhe idh `id time kidy garks, cbme prb`e-vacuke inreekedts ar
rbsm-sfirbdn inreekedts. Kast ag tfe tbke, fawever, tfese inreekedts sbkpcy time tfegark ag sbkpce reoites aggereh ta ouyers (Oaurissi-Gar ber idh Dac, ?:9?= @fawd,
?:9:).
Dat denatbitbdn reoites `id oe `astcy. Bd tfe Udbteh Ptites, tfe Kehb`ire pcid
(`averbdn sedbars) reguses ta denatbite tfe sike reoites is tfe Kehb`ibh pranrik
8 Date tfit ceniccy bd ?:99, up ta ?:% ag tfbs `ast auch na oi`m ta pfirki`bes bd tfe gark ag reoites.
-
7/27/2019 Call growing louder for national prescription drug plan
29/108
I_aihk
iptai_itb
ZfirkiireZacb`ybd@id(`averbdn caw-bd`ake gikbcbes) bd arher ta prate`t tfe bdterests ag pfirki`eutb`ic
`akpidbes. Pu`f id ipprai`f ed`aurines `akpidbes ta bdite tfe ag`bic prb`e, eved
bg bt keids edterbdn bdta reoite denatbitbads wbtf atfer pur`fisers. I``arhbdn ta
tfe U.P. @adnressbadic Ouhnet Ag`e (?:99), Kehb`ires regusic ta denatbite wbcc `ast
Ikerb`id tixpiyers $99? obccbad kare bd tfe dext ted yeirs.
Kast puocb` hrun bdsurid`e pcids five ihapteh `adhedtbic inreekedts `icceh
Zrahu`t Cbstbdn Inreekedts (ZCIs), wfb`f `adsbst ag rebkoursbdn tfe ag`bic (fbnf)
prb`e ag tfe hrun, bd ex`fidne gar `adhedtbic reoites. Xfus kidy issuke tfit tfe
praocek bs sacveh sbd`e @idihbid puocb` ouyers ire usbdn tfebr pur`fisbdn pawer
ta se`ure `adhedtbic reoites. Out, bd gi`t, nettbdn tfese reoites bs passboce adcy
oe`iuse tfe `ast bs sfbgteh ar tridsgerreh ta atfers. @ast sfbgtbdn fippeds bd tfree
wiys< bd`reiseh `asts gar pitbedts= bd`reiseh `asts gar prbvite pcids= idh bd`reiseh`asts gar atfer pravbd`es udioce ta denatbite equiccy suostidtbic reoites.
Zravbd`es su`f is Orbtbsf @acukobi, Davi P`atbi, Icoerti, Yueoe` idh
Pismit`fewid ism pitbedts ta sfire 0:% ta 05% ag tfe `ast ag hruns ar oeir tfe tatic
prb`e ag tfe hruns udtbc tfebr expedses rei`f i `ertibd per`edtine ag tfebr idduic
bd`ake. ^fed tfe pravbd`e cbsts i dew kehb`itbad ad bts pravbd bic garkuciry (ar hrun
oedet cbst),5oe`iuse bt su``eeheh bd nettbdn i suostidtbic reoite, tfe pitbedt stbcc fis
ta piy fbs `a-piykedt ar hehu`tboce i``arhbdn ta tfe ag`bic prb`e, dat i``arhbdn ta
tfe prb`e denatbiteh oefbdh `caseh haars. Bd atfer warhs, bg tfe pravbd`e nets i >5%reoite ad i spe`b` kehb`itbad, tfe pitbedts `a-piykedt rekibds 0:% ag tfe ag`bic
hrun prb`e. Bd tfe edh, tfe `a-piykedt ar hehu`tboce pibh oy tfe pitbedt `id oe, it
tbkes, fbnfer tfid tfe reic prb`e ag tfe prahu`t. Fere, tfe puocb` pcid sives kadey
it tfe expedse ag sb`m peapce wfa rekibd udiwire ag tfe exbsted`e ag ag`bic ar
denatbiteh prb`es.
Darkiccy, prbvite hrun bdsurid`e pcids ha dat denatbite reoites. Bd gi`t, 25%
ag prbvite pcids bd @idihi five aped hrun rebkoursekedt cbsts (garkucirbes) idh
rebkourse idy dew kehb`itbad ad tfe kirmet, wfitever tfe prb`e, wbtfaut id
issesskedt ag bts tferipeutb` vicue (Kirtbdez, ?:99). Kare restrb`tbve prbvite pcids
nedericcy recy ad tfe pravbd`bic puocb` garkuciry ta rebkourse kehb`itbads wfed tfebr
tferipeutb` vicue bs `adsbhereh sug`bedt recitbve ta tfe `ast ag tfe prahu`t. ZCIs
`reite `adgusbad oe`iuse fbnf-prb`eh dew kehb`itbads wbtfaut nreit tferipeutb`
5 Xfe pravbd`bic garkuciry hecbdeites tfe hruns idh kehb`itbads tfe pravbd`es puocb` bdsurid`e pcid rebkourses.
-
7/27/2019 Call growing louder for national prescription drug plan
30/108
-
7/27/2019 Call growing louder for national prescription drug plan
31/108
-
7/27/2019 Call growing louder for national prescription drug plan
32/108
9>
@fipter 0. @idihbid pfirki`eutb`ic pacb`bes. aut`akes bd i grinkedteh systek
0.0. Oucm pur`fisbdn gar pitedteh idh nederb` hruns
Bd Peptekoer ?:9:, tfe @aud`bc ag tfe Geheritbad, kihe up ag @idihis pravbd`bic
idh terrbtarbic prekbers, iddaud`eh tfe `reitbad ag i pid-@idihbid pur`fisbdn
iccbid`e ta pur`fise expedsbve oridh dike hruns. Bd ?:9?, tfe @aud`bc ag tfe
Geheritbad iddaud`eh bt wauch extedh tfe oucm pur`fisbdn iccbid`es (redikeh Zid-
@idihbid Zrb`bdn Iccbid`e) race ta bd`cuhe tfe pur`fise ag `ertibd nederb` hruns. Pbd`e
tfed, tfe @idihi-wbhe iccbid`e>fis adcy pur`fiseh sbx nederb` hruns bd ?:90 (@aud`bc
ag tfe Geheritbad, ?:90), gaur nederb` hruns bd ?:98 (@aud`bc ag tfe Geheritbad ?:98),
idh seved oridh-dike hruns. Denatbitbads ire udherwiy gar tfe oucm pur`fise ag 90
atfer oridh-dike hruns (Ki`Irtfur, ?:90).
Oucm pur`fisbdn bs praoiocy ade ag tfe oest stritenbes bkpcekedteh bd @idihita `adtibd hrun `asts. Dat adcy `id tfe striteny suostidtbiccy rehu`e nederb` hrun
prb`es, bt edioces tfe pur`fise ag oridh dike hruns it i prb`e tfit oetter ree`ts
tfe ihheh tferipeutb` vicue ag tfe prahu`t idh iccaws gar denatbiteh ZCIs wbtfaut
pissbdn tfe ou`m ta atfer pravbd`es. Fawever, `ast sfbgtbdn ta pitbedts idh prbvite
hrun pcids rekibds id bssue.
Bd tfe cist gew yeirs, tfe pfirki`eutb`ic se`tar siw tfe ekerned`e ag i dew
ousbdess kahec oiseh ad very expedsbve db`fe hruns (agted `icceh db`fe ousters),
idh ripbh prb`e bd`reises bd obacanb`ic hruns gar wfb`f we `iddat prahu`e nederb`s.
I oucm pur`fisbdn iccbid`e wbtf i regered`e-prb`bdn systek rekibds tfe kast
`akkedhioce striteny ta edsure i``ess ta dew treitkedts gar icc @idihbids it id
iggarhioce prb`e (Nraatedharst idh Faccbs, ?:99).
I``arhbdn ta Hbide Ki`Irtfur (?:90), Issbstidt Heputy Kbdbster respadsboce gar
Adtirbas puocb` hrun pcid, labdt pur`fisbdn `akes wbtf kidy aosti`ces bd`cuhbdn Xfe Zid-@idihbid Zrb`bdn Iccbid`e haes dat bd`cuhe Yueoe` is tfbs pravbd`e reguses ta labd tfbs bdbtbitbve.
-
7/27/2019 Call growing louder for national prescription drug plan
33/108
I_aihk
iptai_itb
ZfirkiireZacb`ybd@iddenatbite kare sbndb`idt reoites ad bts awd oy ga`usbdn ad pravbd`bic ZCIs, tfed
tfe pur`fisbdn iccbid`e wauch oe ripbhcy `akprakbseh.
Xfit oebdn sibh, oucm pur`fisbdn bs i step bd tfe rbnft hbre`tbad. Evedpfirki`eutb`ic `akpidbes ire bd givaur ag i oetter `aarhbditbad ag tfe prb`e
denatbitbad pra`ess. @idihi represedts i skicc kirmet idh tfe grinkedteh
denatbitbdn pra`ess (ei`f pravbd`e idh terrbtary denatbites ad bts awd) bs iddaybdn
gar tfase `akpidbes. Gar exikpce, bd i presedtitbad ad tfe grinkedtitbad ag tfe
@idihbid hrun rebkoursekedt systek, kihe bd Georuiry ?:90, @ciuhbi Deuoer,
hbre`tar ag prb`bdn idh `adtri tbdn it Istri\ede`i, expcibdeh faw tfe nreit
`akpcexbty ag tfe @idihbid rebkoursekedt systek wis oe`akbdn i reic oirrber
ta puttbdn dew kehb`bdes ad tfe kirmet. Pake `akpidbes sbkpcy hadt heek bt
wartfwfbce idykare ta bdvest bd icc tfe de`essiry resaur`es ta denatbite i``ess tasu`f skicc kirmets (Deuoer, ?:90).
Oucm pur`fisbdn bs essedtbic bd arher ta stidhirhbze tfe pur`fisbdn pra`ess gar
pitedteh hruns bd @idihi idh ta edsure icc pravbd`es oedet grak kixbkuk reoites.
Fawever, tfese reoites rekibd `adhedtbic, is bs tfe `ise wbtf ZCIs. Oucm pur`fisbdn
haes dat edsure tfe sivbdns gar puocb` pcids wbcc de`essirbcy tridscite bdta sivbdns gar
icc @idihbids sbd`e prbvite pcids idh peapce wbtfaut bdsurid`e wbcc `adtbdue ta piy
tfebr kehb`bdes it id bd`reisbdn ag`bic prb`e.
Bd tfe `ise ag nederb`s, tfe ci`m ag udbgarkbty ikadn tfe pravbd`bic pcids icsaudherkbdes tfe wface nraup denatbitbad pra`ess. Gar exikpce, tfe hbggered`es
oetweed rebkoursekedt ketfahs idh oetweed stimefachers bd ei`f pravbd`e gar`e
tfe oucm pur`fisbdn iccbid`e ta icwiys denatbite i prb`e tfit bs i per`edtine ag tfe
pitedteh hrun prb`e (`urredtcy 96%), ritfer tfid tfe iosacute cawest prb`e resuctbdn
grak `akpetbtbve obhhbdn. Pettbdn tfe prb`e ag nederb`s is i per`edtine ag tfe prb`e
ag pitedteh hruns bs dat tfe oest pacb`y bd i se`tar wfere tfere bs kirmet `akpetbtbad
(Faccbs, ?::2). Kareaver, nederb` hrun prb`es bd @idihi rekibd extrekecy fbnf bd
`akpirbsad ta `audtrbes usbdn tfe stredntf ag tfe kirmet ta net tfe oest prb`es, is bs
tfe `ise bd tfe Udbteh Ptites ar Dew \eicidh. Bg bdterpravbd`bic `aarhbditbad praoceks
prevedt tfe eg`bedt denatbitbad ag nederb` hrun iosacute prb`es, idh bg we `adtbdue
ta kibdtibd nederb` hrun prb`es is i gud`tbad ag i per`edtine ag tfe pitedteh hrun
prb`e, we `auch tfed expcare renressbve prb`bdn (rehu`bdn tfe per`edtine ag tfe
prb`e ag tfe pitedteh hrun wbtf tfe bd`reisbdn dukoer ag nederb` `akpetbtars)
(@ikoaurbeu et ic., ?:90).
@akpireh ta atfer `audtrbes, nederb` hruns ire stbcc very `astcy gar @idihbids.
I systekitb` stuhy ag avericc nederb` hrun prb`es oy tfe Ditbadic Zres`rbptbad Hrun
-
7/27/2019 Call growing louder for national prescription drug plan
34/108
-
7/27/2019 Call growing louder for national prescription drug plan
35/108
?
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idkbccbad gar icc ag @idihi grak tfe systekitb` pur`fise ag nederb`s, recybdn kare ad
tfe stredntf ag kirmet `akpetbtbad.
0.8. Bd`reise bd hrun sfartines
Hrun sfartines five steihbcy bd`reiseh bd @idihi sbd`e ?::6. Bd ?:9?, sake
sfartines ag bdle`tioce nederb` hruns reveiceh tfe s`ape ag tfe praocek, pirtb`ucircy
igter i re bd ade ag Pidhazs pcidts (Nindad, ?:9?h). Bdvedtary sfartines ire dat
lust i @idihbid bssue= tfey ire i ncaoic bssue ictfaunf renucitary idh bdstbtutbadic
`rbterbi five kihe tfe praocek warse bd @idihi.
Pake five trbeh ta ocike prb`e `adtrac keisures gar tfe sfartines sbd`e
caambdn gar tfe oest prb`e wauch, tfey sunnest, ceih ta tfe `reitbad ag kadapacbstkidugi`turers wfa `auch, bd pirt, oe respadsboce gar tfe sfartines (Ciorbe, ?:90).
Xfbs expciditbad rekibds praocekitb` oe`iuse eved tfaunf @idihi piys, ad iverine,
ku`f kare tfid kidy hevecapeh `audtrbes, bt stbcc experbed`eh kare bdvedtary
sfartines bd ?:9?. Atfers fbnfcbnft tfe bkpartid`e ag re`edt pcidt bdspe`tbad
renucitary `fidnes bd Dartf Ikerb`i, is wecc is tfe adnabdn ncaoic restru`turbdn ag
tfe nederb` se`tar hue ta i serbes ag kilar kerners idh i`qubsbtbads (Nindad, ?:9?h).
Xfe `iuses ire kuctbpce idh `akpcex out ade tfbdn bs `ceir< tfe pra`urekedt pra`ess
`id bd`reise ar kbtbnite su`f sfartines (Oirtfcky, ?:90= @ikoaurbeu et ic., ?:90).
Xfe pra`urekedt ag hruns bs oiseh ad i pre`irbaus hrun suppcy `fibd `adsbstbdn
ag riw kiterbics, i`tbve bdnrehbedts, kidugi`turers, wfacesicers, hbstrboutars,
faspbtic pfirki`bes idh retibc pfirki`bes. Idy hbsruptbad icadn tfe `fibd `id `iuse
sbndb`idt sta`m sfartines. Xfe @idihbid Zfirki`bsts Issa`bitbad (?:9:) `ceircy
fbnfcbnfteh tfe `urredt praocek bd @idihi, kidugi`turers
kust repart sta`m sfartines sbx kadtfs bd ihvid`e (Attbda et ic., ?:9?). Xfe resucts
ire `advbd`bdn. Bd Kir`f ?:9?, wfed @idihi fih id iverine ag 08>.0 sta`m sfartines
hurbdn tfe kadtf, Grid`e adcy fih 87.6 (Oirtfcky et ic., ?:9?).
Oucm pur`fisbdn ined`bes ire saketbkes ocikeh gar `reitbdn kadapacbes ikadnnederb` hrun kidugi`turers (Ciorbe, ?:90). Bg tfbs bs tfe `ise, wauch i udbque oucm
pur`fisbdn ined`y, su`f is tfe ade bd Dew \eicidh, ceih ta kare sta`m sfartines1
^e five icreihy sfawd tfit oucm pur`fisbdn ined`bes ire dat tfe praocek. Bdsteih,
bt bs tfe cenbscitbve idh renucitary stru`ture oefbdh tfe pur`fisbdn ketfah. Gar
exikpce, bdvbtitbads ta tedher idh suosequedt inreekedts deeh ta bd`cuhe bdhekdbty
idh `adtbdned`y `ciuses. I oucm pur`fisbdn ined`y `auch, bdheeh, oe kare
su``essguc wbtf sta`m sfartine `ciuses, gar exikpce, oy bhedtbgybdn wfb`f hruns ire
kare cbmecy ta na aut ag sta`m idh bhedtbgybdn atfer kidugi`turers.
^auch i udbque oucm pur`fisbdn ined`y ceih ta nreiter bdhustrbic `ad`edtritbad
ikadn nederb` kidugi`turers1 Xfit fypatfesbs bs oiseh ad i kbs`ad`eptbad ag tfe
ncaoic nederb`s kirmet. Bd tfe cist gew yeirs, tfe kilar nederb` hrun `akpidbes
five seed i serbes ag pirtb`ucircy sbndb`idt kerners idh i`qubsbtbads. Xfbs bs hue
ta tfe expcasbad ag tfe nederb` kirmet bd i perbah wfere bkpartidt pitedts ire
rei`fbdn tfebr expbry hite hue ta i pitedt `cbgg. Xfe gaur hakbdidt nederb` se`tar
`akpidbes Xevi, Kycid, Pidhaz (awdeh oy Davirtbs) idh ^itsad represedt 8:%
ag nederb` pres`rbptbads iraudh tfe warch. Icc recy ad kerners idh i`qubsbtbads is i
prbkiry striteny ta nraw tfebr sfire ag tfe kirmet (Firhbdn, ?:9:). Nbved tfe nrawtf
ag tfe se`tar, idh tfe gi`t tfit pcidts gud`tbad it gucc `ipi`bty, tfese kerners idh
i`qubsbtbads agted requbre sbndb`idt issekocy cbde restru`turbdn, idh ire agted id
bkpartidt gi`tar bd tfe bd`reise bd sfartines (Nindad, ?:9?h).
Xfe bd`reisbdn kadapacy pawer bd tfe nederb` se`tar bs daw warchwbhe, idh bs
dat `adtbdnedt ad tfe pur`fisbdn ketfah bd pci`e bd @idihi. Bd gi`t, oucm pur`fisbdn,
`akobdeh wbtf `adservitbve pur`fisbdn `ciuses ta edsure pra`urekedt stiobcbty,
-
7/27/2019 Call growing louder for national prescription drug plan
38/108
-
7/27/2019 Call growing louder for national prescription drug plan
39/108
I_aihk
iptai
_itbadicZfirk
iire
Zacb`ybd@idihi
?
@fipter 8
Xfe@acce
tbve@ast
agZrbviteBdsuride
Xfbs se`tbad wbcc rst ihhress tfe ekernbdn `adsedsus ad regarkbdn hrun
bdsurid`e. Pe`adh, bt wbcc hekadstrite faw exbstbdn prbvite hrun pcids ire pirt ag
tfe praocek idh dat tfe sacutbad tfraunf tfe idicyses ag gaur stru`turic praoceks
issa`biteh wbtf prbvite kehb`ic bdsurid`e< smbkkbdn, wiste, tix suosbhbes idh
ihkbdbstritbve `asts.
8.9. Ekernbdn `adsedsus
Is udhercbdeh oy Idhr Zb`irh (Ncaoe idh Kibc ?:90), i `adsedsus bs oenbddbdn
ta ekerne renirhbdn de`essiry hrun bdsurid`e regarks. Bd Lude ?:90, Xfe @.H. Fawe
Bdstbtute, i wecc-mdawd puocb` pacb`y tfbdm tidm, edharseh tfe bhei ag i puocb` idh
udbversic hrun `averine pcid wfed bt requesteh tfe bdtenritbad ag pres`rbptbad hruns
bdta tfe `urredt @idihbid puocb` feictf bdsurid`e pcid (Karnid, Hiw idh Ciw, ?:90).
^e taticcy inree wbtf tfe `ad`cusbads ag tfe @.H. Fawe Bdstbtute bd tfbs respe`t. Xfbs
wis gaccaweh oy i repart grak tfe @idihbid Cbge idh Feictf Bdsurid`e Issa`bitbad
(@CFBI, ?:90) re`akkedhbdn urnedt hrun `averine regarks ta edsure oetter puocb`
-
7/27/2019 Call growing louder for national prescription drug plan
40/108
-
7/27/2019 Call growing louder for national prescription drug plan
41/108
-
7/27/2019 Call growing louder for national prescription drug plan
42/108
-
7/27/2019 Call growing louder for national prescription drug plan
43/108
-
7/27/2019 Call growing louder for national prescription drug plan
44/108
?2
@fipter 8. Xfe @acce`tbve @ast ag Zrbvite Bdsurid`e
@idihi aggers nederaus did`bic bd`edtbves tfraunf tix suosbhbes. Xfe tix suosbhbes
ire sbkpce< tfe ekpcayers `adtrboutbad ta tfe hrun pcid (`arrespadhbdn ta i pirt
ag tfe siciry) bs tix gree. Xferegare, tfere bs da bd`ake tix ad tfit partbad ag tfe
siciry. @adsequedtcy, tfe kare yau eird, idh tfe fbnfer yaur kirnbdic tix rite bs,
tfe kare yau oedet grak tfbs tix suosbhy. Xfe dic resuct bs i tix suosbhy systek
tfit bs `akpcetecy renressbve, wfere tfe rb`fer yau ire, tfe kare yau oedet grak
tix suosbhbes. Bd ?::2, tix suosbhbes aggereh oy tfe geheric naverdkedt represedteh
iraudh 90% ag tfe `asts ag prbvite pcids, ikaudtbdn ta $9.? obccbad bd ?::2 (Nindad,
?:9?o). It tfe pravbd`bic cevec, fawever, tfe cevec ag tix suosbhbes bs udmdawd.
Bt kust oe ekpfisbzeh tfit Yueoe` bs hbggeredt6bd aggerbdn puocb` hrun `averine
ta everyoahy wbtfaut prbvite `averine. Kareaver, Yueoe` haes dat agger idy tix
suosbhy ta `akpidbes wfase oedets pranriks bd`cuhe hrun `averine. Xfed, faw`id prbvite hrun bdsurid`e survbve bd Yueoe`1 Bt survbves oe`iuse bt bs kidhitary62 kbccbad is `akpireh ta
tfe ?:9: estbkites9:(Nindad & Foert, ?:9:).
Xfe prapartbad ag ihkbdbstritbve `asts gar icc prbvite pcids (gar-prat idh dat-gar-
prat) hauoceh bd ?: yeirs. Fawever, bt seeks tfe @CFBI bs dat trybdn ta rehu`e tfase
2 Xfe @idihbid Bdstbtute gar Feictf Bdgarkitbad repart (@BFB ?:90o) bd`cuhes regered`e ta prbvite ihkbdbstritbad`asts oebdn 7.8% ag icc prbvite feictf `ire spedhbdn, bd`cuhbdn prbvite spedhbdn tfit hbh dat aw tfraunfprbvite bdsurid`e `akpidbes. Xfe ippraprbite stitbstb` bs tfe sfire ag prbvite feictf bdsurid`e spedhbdn bd@idihi, wfb`f bs ittrboutioce ta prbvite bdsurid`e ihkbdbstritbad< 97%.
9: Xfe ecbkbditbad ag tfe ihkbdbstritbve `asts it tfit tbke wis oiseh ad i 7% hbggered e gar prbvite feictfpcids idh represedteh sivbdns ag $57: kbccbad. Ihhbtbadic sivbdns ire oiseh ad i dew `ic`ucitbad oiseh ad ihbggered`e ag 98.?%.
-
7/27/2019 Call growing louder for national prescription drug plan
46/108
09
@fipter 8. Xfe @acce`tbve @ast ag Zrbvite Bdsurid`e
`asts bd idy wiy, pirtb`ucircy bg we `adsbher tfit ihkbdbstritbve `asts bd`cuhe tfe
bdsurid`e `akpidbes prat kirnbd.
Zrbvite feictf bdsurid`e pcids ire dat adcy `astcy idh bdeg`bedt, tfebr kereexbsted`e prevedts id egge`tbve aarhbditbad ag pfirki`eutb`ic pacb`bes tfit wauch
edsure equbtioce idh de`essiry hrun i``ess gar icc @idihbids wfbce prevedtbdn
`ast bd`reises. Gar icc tfese reisads, we oecbeve tfit bt bs tbke ta `adsbher tfe
bkpcekedtitbad ag i udbversic pfirki`ire pranrik ta oedet icc @idihbids.
-
7/27/2019 Call growing louder for national prescription drug plan
47/108
I_aihk
iptai
_itbadicZfirk
iire
Zacb`ybd@idihi
0
@fipter 5
Guturesedirbas
gar@idihi
Xfbs se`tbad presedts id uphite ag tfe estbkiteh did`bic bkpi`t i udbversicpfirki`ire pranrik wauch five ad @idihi, wfbce icsa bhedtbgybdn bts patedtbic
gudhbdn s`edirbas.
5.9. @asts idh oedets issa`biteh wbtf i udbversic pfirki`ire pranrik
Bd Xfe E`adakb` @ise gar Udbversic Zfirki`ire(Nindad & Foert, ?:9:), bt wis
sfawd tfit tfe bkpcekedtitbad ag i puocb` idh udbversic hrun pcid bd @idihi, eved
wbtf rst-haccir `averine gar tfe wface papucitbad, idh wbtfaut rehu`bdn tfe prb`e
ag pitedteh hruns, `auch ceih ta sivbdns ag up ta $?,28> kbccbad ar 9?% ag tfe `ast agpres`rbptbad hruns bd @idihi. Bd tfe ?:9: repart, tfe `asts idh oedets ag i udbversic
pfirki`ire pranrik were oiseh, bd pirt, ad tfe ?::6 ehbtbad ag tfe @idihbid _x
Itcis (Karnid et ic., ?::6). Gbnure > sfaws tfe resucts ag tfe ?:9: idicysbs (Nindad
idh Foert, ?:9:).
-
7/27/2019 Call growing louder for national prescription drug plan
48/108
00
@fipter 5. Guture s`edirbas gar @idihi
Gbnure >
Estbkite (grak ?::6 hiti) ag `asts idh sivbdns nederiteh oy i udbversicpfirki`ire pranrik, meepbdn tfe sike bdhustrbic pacb`bes bd terks ag hrun`asts
9. Zres`rbptbad hrun expedhbtures bd ?::6 $?5,989 kbccbad
Hbstrboutbad ag pres`rbptbad hrun asts/oedets
?. Nrawtf bd expedhbtures grak bd`reise bd use +9:% ag urredt expedhbture
0. _ehu tbad bd expedhbtures grak he reise bd hbspedsbdn gees -?% ag `urredt expedhbture
8. _ehu`tbad bd expedhbtures grak hrun issesskedt -6% ag urredt expedhbture
5. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` -$988 kbccbad
7. Ecbkbditbad ag reoite systeks gar nederb`s -$9,09: kbccbad
Xatic sivbdns ad pres`rbptbad hruns -$9,858 kbccbad
Xatic pres`rbptbad hrun expedhbtures wbtf i udbversic
pfirki`ire pcid$?0,76> kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
>. Ecbkbditbad ag extri ihkbdbstritbve asts ag prbvite pcids -$57: kbccbad
6. Ecbkbditbad ag tix suosbhbes -$200 kbccbad
Xatic ag ihhbtbadic bkpi`ts -$9,820 kbccbad
Xatic det sivbdns $?,28> kbccbad
Paur`e< Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
49/108
-
7/27/2019 Call growing louder for national prescription drug plan
50/108
-
7/27/2019 Call growing louder for national prescription drug plan
51/108
-
7/27/2019 Call growing louder for national prescription drug plan
52/108
-
7/27/2019 Call growing louder for national prescription drug plan
53/108
-
7/27/2019 Call growing louder for national prescription drug plan
54/108
02
@fipter 5. Guture s`edirbas gar @idihi
Igter uphitbdn hiti, we `id tferegare estbkite tfit tfe bkpcekedtitbad ag i
udbversic pfirki`ire pranrik, oiseh ad i rst-haccir `averine, set up `adlabdtcy
wbtf i ditbadic garkuciry idh i oucm pur`fisbdn iccbid`e gar nederb`s, idh eg`bedt
bdstbtutbads tfit kime aptbkic use ag tfe kehb`itbad, `auch i`fbeve sivbdns ag $?.>
obccbad bd pres`rbptbad hruns (ar 9:% ag expedses) per yeir wfbce iccawbdn equic
hrun i``ess idh bkpraveh feictf gar icc @idihbids. Xfese sivbdns wauch dat bd`ur
ihhbtbadic `asts bd atfer feictf systek ireis. Ad tfe `adtriry, udbversic idh bkpraveh
i``ess ta kehb`itbads wauch edsure praper aoservid`e ag kehb`ic pres`rbptbads
idh i kare ritbadic use ag hruns, twa gi`tars tfit wauch sbndb`idtcy rehu`e
faspbticbzitbad `asts idh pfysb`bid vbsbts.
5.?. Id edh ta irtb`biccy bditeh pitedteh hrun prb`e
Xfbs estbkitbad haes dat time bdta i``audt tfe ihhbtbadic sivbdns tfit `auch
oe aotibdeh oy revbsbdn hawdwirh tfe `ast ag pitedteh hruns bd @idihi. Xfe
E`adakb` @ise gar Udbversic Zfirki`ire (Nindad idh Foert, ?:9:) sfaweh faw
@idihi irtb`biccy bditeh pitedteh hrun prb`es bd arher ta ittri`t bdvestkedts oy
pfirki`eutb`ic `akpidbes. Xfese pacb`bes five oeed i `akpcete gibcure. Bd spbte ag
tfe irtb`biccy bditeh `asts pibh gar pitedteh hruns idh, bd spbte ag tfe gi`t tfit aur
pitedteh hrun prb`es ire ikadnst tfe fbnfest bd tfe warch, @idihbids five seed
reseir`f idh hevecapkedt expedhbtures rehu`eh obt oy obt ta ickast datfbdn bd tfe
cist 9: yeirs. Xfe pitedteh hrun bdhustry fis eved garsimed bts `akkbtkedt ta bdvest
9:% ag bts sices bdta reseir`f idh hevecapkedt (Nindad, ?:9?`). I``arhbdn ta i stuhy
udherwrbtted oy tfe pitedt pfirki`eutb`ic bdhustry caooy (Zrb`e iterfause@aaper
?::5), _x&H kekoer `akpidbes ekpcayeh ??,00? persads bd ?::0. _x&H weosbte
daw bdhb`ites tfit tfe bdhustry ekpcayeh adcy 98,22: persads bd ?:9?, i hrap ag 9/0
ag ekpcayees aver 9: yeirs.
Xfe Zitedteh Kehb`bde Zrb`es _evbew Oairh (ZKZ_O), wfb`f renucites pitedteh
hrun prb`es bd i wiy `adsbhereh givaurioce ta tfe bdhustry, bs daw siybdn tfit tfe
`ad`ept ag pitedteh hrun prb`e bd`reises ceihbdn ta bdvestkedts bd reseir`f idhhevecapkedt bs i giucty `cibk (ZKO_O, ?:90) ta ?::>, reic per `ipbti hrun prb`e nrawtf wis ad iverine
5.?% per yeir bd @idihi, wfbce adcy :.6% yeircy bd Dew \eicidh (@BFB, ?:9?). Pbd`e
?::>, tfe tredh fis oeed ictereh gar tfe sike reisads oefbdh tfe he`reise ag tfe
tferipeutb` `fab`e egge`t bd O@ (see Pe`tbad 5.9.8). AE@H Feictf hiti oetweed ?::>
idh ?:99 bdhb`ites tfit tfe reic per `ipbti `ast ag kehb`itbad bd @idihi bd`reiseh
ad iverine oy 9.?% (wfb`f oedetteh grak pitedteh oca`mouster hrun expbry, bd
ihhbtbad ta sbndb`idtcy rehu`bdn tfe `ast ag nederb`s), wfbce tfe reic per `ipbti `ast
ag kehb`itbad bd`reiseh oy ?.9% aver 8 yeirs bd Dew \eicidh. Bd gi`t, Dew \eicidh
icreihy edlayeh cawer prb`es gar nederb` hruns idh cess use ag pitedteh hruns. ^fbcetimbdn bdta i``audt tfe patedtbic sivbdns gar @idihi, bg we ihapteh tfe Dew \eicidh
kahec, we `auch edlay sivbdns ag $2.2? obccbad ad tfe tatic `asts ag kehb`itbad
ad id adnabdn oisbs. Gbnure 2 uphites tfe patedtbic did`bic bkpi`t grak tfe
bkpcekedtitbad ag i udbversic pfirki`ire pranrik tfit times ihvidtine ag sivbdns
-
7/27/2019 Call growing louder for national prescription drug plan
56/108
89
@fipter 5. Guture s`edirbas gar @idihi
kixbkbsitbad stritenbes gar hrun `asts tfraunf utbcbzbdn bdstbtutbadic `ipi`btbes is bd
tfe `ise ag Dew \eicidh.
Gbnure 2@ast idh sivbdns estbkitbads grak bkpcekedtitbad ag i @idihbid udbversicpfirki`ire pranrik wbtf repeic ag bdhustrbic pacb`bes issa`biteh ta hrun `astsoiseh ad ?:9?-?:90 nures
9. @urredt expedses bd pres`rbptbad kehb`itbad $?>,>08 kbccbad
Icca`itbad ag `asts/prats bd pres`rboeh kehb`itbads
Pivbdns per akpetbtbve prb`bdn -$2,2?: kbccbad
?. Expedses bd`reise oy adsukptbad bd`reise +9:% ag expedhbtures
0. Expedses he`reise i``arhbdn ta he`reise bd hbspedsbdn gees -?% ag expedhbtures
5. Ecbkbditbad ag kadtfcy hehu`tboce Yueoe` -$078 kbccbad
Xatic sivbdns gar pres`rbptbad hruns -$6,625 kbccbad
Xatic expedses gar pres`rbptbad hruns wbtfbd i udbversic
pfirki`ire pranrik$96,602 kbccbad
Ihhbtbadic bkpi`ts (atfer tfid pres`rbptbad hruns)
>. Ecbkbditbdn prbvite pcid ihkbdbstritbve asts -$9,082 kbccbad
6. Ecbkbditbdn tix suosbhbes -$9,?:8 kbccbad
Xatic ihhbtbadic bkpi`ts -$?,550 kbccbad
Xatic oicid`e ag sivbdns$99,886 kbccbad
(89% ag expedhbtures)
Paur`e< Iutfars nures= Nindad idh Foert, ?:9:
Xfe bkpcekedtitbad ag i udbversic pfirki`ire pranrik oiseh ad rst-haccir
`averine, icadn wbtf tfe repeic ag irtb`bic idh usecess prb`e bditbad is bdhustrbic
pacb`y, tfe ippcb`itbad ag saudh bdstbtutbadic `ipi`btbes gar kixbkbsbdn hrun pur`fise
sivbdns (is bd tfe `ise ag Dew \eicidh) wauch iccaw gar $99.8 obccbad bd sivbdns, ar 89%
ag presedt hiy pres`rbptbad hrun spedhbdn.
Date tfit fbnfcbnftbdn tfe Dew \eicidh kahec haes dat bdhb`ite i `icc gar bts
`akpcete bkpcekedtitbad bd @idihi. Xfe kahec bs useguc fere ta hekadstrite tfe
wbhe ridne ag aptbads passboce udher i udbversic pfirki`ire pranrik tfit kixbkbses
i papucitbads kehb`ic spedhbdn oedets. @adservitbve s`ic pacb`y bd tfe feictf ech
haes dat de`essirbcy keid tfit we five ta rehu`e naverdkedt spedhbdn= bt kerecy
-
7/27/2019 Call growing louder for national prescription drug plan
57/108
-
7/27/2019 Call growing louder for national prescription drug plan
58/108
80
@fipter 5. Guture s`edirbas gar @idihi
cissurid`e-kicihbe hu Yuoe` (_IKY), bs oiseh ad i fyorbh did`bdn ketfah
`akobdbdn sa`bic bdsurid`e idh gudhbdn tfaunf bd`ake tixes. Xfe pcid tirnets
twa `itenarbes ag persads< tfase udioce ta warm wfa ha dat hepedh did`biccy ad
sakeade ioce ta warm (sedbars idh wecgire re`bpbedts), idh tfase ioce ta warm, idh
tfebr hepedhedts (wfb`f bd`cuhes everyoahy ecse dat `avereh oy i prbvite hrun pcid)
(_IKY weosbte, ?:90). Hrun `averine gar peapce udioce ta warm rests ad i ritbadice
ag sa`bic issbstid`e. Is bd tfe atfer pravbd`es, Yueoe`s hrun `averine gudhbdn gar tfbs
`itenary `akes rst grak tixes.99
Idy persad ioce ta warm idh `avereh oy tfe puocb` hrun pcid (tfe pirtb`bpidts)
kust five i prekbuk oiseh ad fbs ar fer bd`ake, up ta i kixbkuk ag $5>2 per yeir
(is ag He`ekoer ?:9?). Xfe ikaudt ag tfe prekbuk gar tfe pirtb`bpidts bs heterkbdeh
bd su`f i wiy ta `aver icc expedses gar pirtb`bpidts. Xfe iverine prekbuk ag prbvitehrun pcids bs udmdawd, out tfe keid `ast ag pirtb`bpidts `cibks bs $600 per yeir
(Express P`rbpts @idihi, ?:9?). Ad iverine, tfe prekbuks kust `aver tfit ikaudt
gar ei`f persad is wecc is tfe ihhbtbadic ihkbdbstritbve `asts. ^e `id tfed `ad`cuhe
tfit prekbuks ire fbnfer gar prbvite pcids tfid gar puocb` pcids, tfit bs ta siy, it ceist
$0:: kare, ad iverine, oy persad.
^fit wauch fipped bg takarraw Yueoe` extedheh bts `averine ta icc warmers1
^auch tfe did`bic ourhed oe tridsgerreh ta tixpiyers idh, tfus, tfe s`ic caih ar tfe
he`bt ag tfe pravbd`e bd`reise i``arhbdncy1 ^auch su`f i he`bsbad oe brrespadsboce
bd terks ag puocb` did`e1 Dat bd tfe ceist. Every warmer piybdn prekbuks wbtfbd
tfebr prbvite pcid (tfraunf i kidhitary hehu`tbad it tfe saur`e) wauch daw stbcc
piy i prekbuk tfraunf i kidhitary hehu`tbad it tfe saur`e. Gar tfe warmer, tfe
obn hbggered`e wauch oe i prekbuk sbndb`idtcy cawer, idh fe ar sfe wauch see i
sbndb`idt bd`reise bd fbs ar fer hbspasioce bd`ake. Ag `aurse, we wauch deeh ta
`akpedsite gar tfe cast tix revedues grak tixbdn prekbuks bd prbvite pcids (2% gar
ekpcayees idh ?.05% gar ekpcayers). Yueoe` `auch tfed heterkbde i kixbkuk
ikaudt ag $775, ritfer tfid $5>2 gar tfe prekbuk, `ic`uciteh is i gud`tbad ag bd`ake.
Xfe resuct wauch oe tfe sike gar tfe warmers< tfey stbcc wauch five hrun `averine out
tfebr hbspasioce bd`ake wauch bd`reise.
^auch tfe ekpcayee case ad tfe ex`fidne sbd`e fe ar sfe daw piys tfe prekbuks
wbtfaut tfe ekpcayers `adtrboutbad1 Xfe irnukedt haes dat fach oe`iuse tfe
ekpcayers sivbdns `auch oe re`aupeh ritfer eisbcy oy ekpcayees tfraunf atfer
99 Bd Yueoe`, fawever, sedbars wfa ha dat oedet grak id bd`ake suppcekedt kust piy i prekbuk gar tfebr hrun`averine, i``arhbdn ta tfebr bd`ake. Pedbars wfa oedet grak 28% ar kare bd bd`ake suppcekedt, is wecc ispeapce ad sa`bic issbstid`e, ha dat piy idy prekbuk.
-
7/27/2019 Call growing louder for national prescription drug plan
59/108
8
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idecekedts bd tfe `acce`tbve inreekedt. Idatfer passbobcbty bs, bdsteih ag aggerbdn hrun
`averine is pirt ag tfe oedets pranrik, tfe ekpcayer `auch `aver tfe ikaudt ag tfe
prekbuks wbtfbd tfe puocb` pcid. Xfere bs da kilar bdstbtutbadic oirrber ta prevedt su`f
id ihlustkedt.
Bd tfe edh, tfe ekpcayee wauch stbcc five hrun `averine, piy cess gar prekbuks,
idh edlay kare hbspasioce bd`ake. Yueoe` wauch dat five ta bd`reise tixes idh
wauch oe oetter pasbtbadeh ta oubch tfe bdstbtutbadic `ipi`btbes bt deehs ta kare
egge`tbvecy `adtrac `asts, gar exikpce oy estiocbsfbdn i oucm pur`fisbdn ined`y idh
edsurbdn bt pur`fises kehb`bdes ag praved vicue gar kadey.
Usbdn Yueoe` is id exikpce ag i fyorbh did`bdn stru`ture, gudheh tfraunf
bd`ake tix gar peapce udioce ta warm idh tfraunf sa`bic bdsurid`e prbd`bpces
(prekbuks) gar peapce ioce ta warm, `auch edioce us ta skaatfcy kime tfe tridsbtbad
ta i puocb` idh udbversic pcid wbtfaut bd`reisbdn idyades tix ourhed wfbce bd`reisbdn
warmers hbspasioce bd`ake.
Idy pacbtb`ic pirty prapasbdn tfe bkpcekedtitbad ag i udbversic pfirki`ire
pranrik `auch bd`cuhe bd bts ece`taric `ikpibnd tfe prapasic ta edsure oetter i``ess
ta hruns gar icc @idihbids idh ta orbhne tfe nips bd aur feictf `ire systek wfbce
bd`reisbdn warmers hbspasioce bd`ake. Bd sukkiry, wbtf i cbttce pacbtb`ic wbcc, @idihi
`auch diccy edter tfe VVB `edtury.
Ret sfauch i udbversic pcid oe udbque idh pid-@idihbid1 Dat de`essirbcy.
Aovbauscy, tfe sbkpcest wiy wauch oe ta bd`cuhe pres`rbptbad hruns bd tfe `urredt
puocb` feictf `ire systek. Fawever, su`f i pcid `auch icsa oe bkpcekedteh bd ade
pravbd`e adcy ar bd i renbad, gar exikpce, tfe Zribrbes ar tfe Kirbtbkes. Xfit oebdn sibh,
`aaperitbad idh `accioaritbad oetweed pravbd`es rekibds gudhikedtic ta edsurbdn
eg`bedt idh equbtioce `averine gar icc.
^fit race sfauch Attiwi pciy1 Bs feictf `ire sbkpcy i pravbd`bic lurbshb`tbad1
Ade sfauch date tfit tfbs bs dat exi`tcy wfit tfe @idihbid @adstbtutbad siys. _itfer,
tfe @idihbid @adstbtutbad siys tfit feictf `ire estiocbsfkedts `ake udher tfepravbd`bic lurbshb`tbad (s.2?(>)) wfbce tfe `rbkbdic ciw renucitbdn hruns idh dir`atb`s
(bd`cuhbdn kehb`bdes) `akes udher tfe Geheric lurbshb`tbad. Zitedt ciw bs icsa i
Geheric lurbshb`tbad (s.29(??)). Xfese `adstbtutbadic ecekedts expcibd wfy hrun
ippravic idh tfe renucitbad ag pitedteh hrun prb`es ire hade oy geheric arnidbzitbads6% ag @idihbids ire bd givaur ag estiocbsfbdn i
udbversic pfirki`ire pranrik bd @idihi (EMAP ?:90). Xfe geheric naverdkedt fis icc
tfe taacs de`essiry ta issuke ceihersfbp gar hrun bdsurid`e, bkpcekedt tfe de`essiry
regarks ta edsure oetter i``ess ta hruns, agger i kare eg`bedt pcid, idh `adtrac `asts.
Fawever, grak i prinkitb` perspe`tbve, sbd`e tfe @adservitbve geheric naverdkedtbs trybdn ta ioidhad icc respadsbobcbty gar feictf `ire, we fape bt wadt put aosti`ces
bd tfe wiy ag @idihbids wbsfbdn ta diccy oe `avereh oy i udbversic pfirki`ire
pranrik wartfy ag tfe VVB `edtury.
@fipter 5. Guture s`edirbas gar @idihi
-
7/27/2019 Call growing louder for national prescription drug plan
61/108
I_aihk
iptai
_itbadicZfirk
iire
Zacb`ybd@idihi
8
@fipter 7
_aihkipt
ai
ritbadichrunpacb`y
Xfe @idihbid hrun bdsurid`e systek bs id idakicy ikadn AE@H `audtrbesoe`iuse kehb`itbads ire dat bd`cuheh bd tfe puocb` feictf `ire systek. Kareaver,
tfe @idihbid systek bs udbque oe`iuse ag tfe grinkedteh bdstbtutbadic stru`tures
ag ei`f pravbd`e, idh tfe gi`t tfit bt recbes ad prbvite bdsurers ta `aver kast ag tfe
papucitbad. Pu`f i systek bs bdeg`bedt, bdequbtioce, wisteguc idh udsustibdioce bd
tfe cadn rud. @ad`cusbad
ta revbse idh icter `astcy idh bdeg`bedt bdhustrbic pacb`bes tfit irtb`biccy bdite
pres`rbptbad hrun `asts oiseh ad tfe bccusbad tfit bt kbnft ittri`t kare bdvestkedts.
^fbce @idihi bs rbsmbdn bts feictf systeks survbvic, bd tfe fapes ag aggerbdn evednreiter bdhustrbic `ast perms ta ittri`t ecusbve pfirki`eutb`ic rk bdvestkedts, tfe
citter five `ceircy cegt @idihi oy tfe wiysbhe sbd`e tfe dukoer ag ekpcayees bd tfe
pitedteh hrun bdhustry fis hrappeh grak ??,00? bd ?::0 (Zrb`e^iterfause@aaper,
?::5) ta 98,22: bd ?:9?. Xfe agger ag fbnfer prb`es fis dat oraunft bd kare
bdvestkedts, is kedtbadeh oy tfe ZKZ_O. ^e `id adcy fape tfit, bd cbnft ag tfese
gi`ts, @idihi respadhs ta tfe bdhustrbic `ficcednes bd tfbs se`tar oy hevecapbdn i
ritbadic bdhustrbic pacb`y idh staps hribdbdn feictf `ire ouhnets. Xaa agted, we ire
udher tfe bkpressbad tfit tfe kibd appasbtbad ta udbversic pfirki`ire `akes grak
peapce wfa kibdtibd i hbsnubseh renbke ag suosbhbes ta tfe bdhustry. Bd tfe keidtbke,icc @idihbids `adtbdue ta piy gar aur pacb`y kimers aostbdi`y bd kibdtibdbdn
brritbadic idh bdeg`bedt pfirki`eutb`ic pacb`bes.
Bd Kiy ?:90, e`adakbst _aoert Evids (?:90) rekbdheh us tfit tfe expedses
ag sake bdhbvbhuics ire tfe revedues ag atfers idh tfit tfe kibd praocek wbtf i
udbversic hrun pcid bs dat tfit bt wauch oe taa expedsbve out ritfer tfit bt wauch
nederite ex`essbve sivbdns. I``arhbdncy, every sivbdn bs icsa i cass ag revedue gar
atfers< `arparite prats tfit fach i hedbte pacbtb`ic bdued`e. ^e `id tferegare
expe`t tfit `ertibd i`tars bd tfbs s`edirba wbcc exert tfebr pawer ta pre-iddbfbcite, idhprevedt, tfe `reitbad ag idy type ag puocb`, udbversic, ritbadic idh eg`bedt hrun pcid.
Xfe deeh gar i udbversic pfirki`ire pranrik bs ade ag tfe rire bssues `reitbdn
`adsedsus ikadn idicysts grak i`rass tfe pacbtb`ic spe`truk. Gbdiccy, cet us
rebterite tfit >6% ag @idihbids suppart i udbversic pfirki`ire pranrik, idh
6?% suppart oucm pur`fisbdn ta rehu`e tfe `asts ag hruns (EMAP, ?:90). Igter
presedtbdn i prinkitb` raihkip gar i ditbadic hrun pcid pacb`y, icadn wbtf tfe
bdstbtutbadic `ipi`btbes de`essiry ta aotibd idh bkpcekedt ritbadic idh ippraprbite
pfirki`eutb`ic pacb`bes, we `id adcy fape tfit tfe pacbtb`ic wbcc ag aur ceihers wbcc
diccy icbnd wbtf tfe puocb` wbcc.
-
7/27/2019 Call growing louder for national prescription drug plan
69/108
5
Igterwarh
KbmeK
`Oide
I_aihk
iptai
_itbadicZfirk
iire
Zacb`ybd@idihi
B five pitbedts siybdn, B lust `idt iggarh tfbs, B ik nabdn ta five ta cbve wbtfky bccdess. Hruns gar fepitbtbs @ `ast bd tfe $6:,::: ridne, oeyadh tfe
rei`f ag kast wfa kust piy gar tfebr awd kehb`bde. ^e hesperitecy deeh i
ditbadic pfirki`eutb`ic striteny.
Hr. Legg Xurdoucc, @fbeg ag Ptigg, Attiwi Faspbtic
Kir`-Idhr Nindads _aihkip ta i _itbadic Zfirki`ire Zacb`y bd @idihiwbcc
put id edh ta tfe suggerbdn tfit feictf pravbhers cbme Hr. Xurdoucc see every hiy bd
tfebr pri`tb`es oy edsurbdn equbtioce i``ess ta hruns gar icc @idihbids. @audterbdntfe `advedtbadic wbshak, tfe _aihkip sfaws faw edsurbdn tfbs i``ess bs edtbrecy
wbtfbd rei`f, idh wauch bd gi`t `adtrac tfe `ast ag hruns tfraunf oucm pur`fisbdn
idh kare ippraprbite use ag kehb`itbads.
Bt bs firh ta averestbkite tfe bkpartid`e ag Zragessar Nindads warm. Fe bs
pravbhbdn sacutbads ta ade ag feictf `ires nreitest `ficcednes< faw ta edsure i``ess
gar icc @idihbids ta essedtbic kehb`bdes idh it tfe sike tbke prate`t @idihbids,
-
7/27/2019 Call growing louder for national prescription drug plan
70/108
-
7/27/2019 Call growing louder for national prescription drug plan
71/108
5
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idgeheric pfirki`eutb`ic pacb`y xes tfe bdtrahu`tary prb`e ag pres`rbptbad hruns
it ippraxbkitecy 0:% ioave tfe AE@H iverine. Bt bs perverse gar tfe geheric
naverdkedt ta ed`aurine tfe ex`essbve nrawtf bd pres`rbptbad hrun `asts is wecc is
iousbve kirmetbdn oefivbar idh bccenic hrun ihvertbsbdn, idh ta tfed piss adta atfers
tfe `ast idh tfe hikine.
Is Zragessar Nindad `advbd`bdncy sfaws, puocb` hrun bdsurid`e bs tfe sacutbad
ta tfe `urredt grinkedteh systek tfit recbes taa ku`f ad expedsbve idh bdeg`bedt
prbvite hrun bdsurid`e. Zrbvite kirmets idh `akker`bic `akpetbtbad five kihe
tfbdns warse, dat oetter, gar aur feictf `ire systek. Kirmets, is Zragessar Irdach
_eckid ag Firvirh Udbversbty rekbdhs us, ire dat hesbndeh ta egge`tbvecy hecbver
kehb`ic `ire, wfb`f bs i sa`bic gud`tbad ta oe ihhresseh bd tfe puocb` se`tar.
Xfe _aihkipsfaws us faw we `id stredntfed aur feictf `ire systek ta `aver
everyade, sive kadey idh sive cbves. Bt ceihs ta wfit Xakky Hauncis `icceh tfe
se`adh stine ag kehb`ire, idh wfit Icex Fbkecgiro `iccs kehb`ire ?.:. Xfey ire
regerrbdn ta i feictf `ire systek tfit ga`uses ad prevedtbad, feictf prakatbad idh
`akprefedsbve, bdtenriteh servb`es. I udbversic puocb` hrun pcid, tanetfer wbtf fake
idh `adtbdubdn `ire, ire tfe stritenb` bddavitbads we deeh ta edsure kehb`ire bs
iggarhioce, equbtioce idh eg`bedt.
Kbme K`Oide
Ditbadic @aarhbditar, @idihbid Feictf @aicbtbad
-
7/27/2019 Call growing louder for national prescription drug plan
72/108
-
7/27/2019 Call growing louder for national prescription drug plan
73/108
5
I_aihk
iptai_itb
ZfirkiireZacb`ybd@id@aud`bc ag tfe Geheritbad. (?:90). Zravbd`es idh Xerrbtarbes Peem Pbndb`idt @ast Pivbdns gar @idihbids
ad Nederb` Hruns. Zress receise, Liduiry 96, ?:90. fttp:-gi`t-sfeet-ad-pid-`idihbid-pfirki`eutb`ic-bdbtbitbves
@auture, Z. (?:90). Khb`ikedts ndrbques< Ces oibsses he prbx dadt likibs eu cbeu. Ce Pacebc, Lude 92, ?:90.
Hiw, L., Karnid, P. (?:9?). Ptbt`fbdn tfe nips bd tfe @idihbid puocb` hrun `averine pit`fwarm1 I revbew
ag pravbd`bic pfirki`ire pacb`y `fidnes grak ?::: ta ?:9:. Feictf Zacb`y, 9:8(9)< 92-?7.
Hekers, W. et ic. (?::6). @akpirbsad ag pravbd`bic pres`rbptbad hrun pcids idh tfe bkpi`t ad pitbedtsidduic hrun expedhbtures. @KIL, 9>6(8).
Harkutf, @. et ic. (?:9?). Egge`t ag i @edtricbzeh Zres`rbptbad Detwarm ad Bdippraprbite Zres`rbptbads gar
Apbabh Idicnesb`s idh Oedzahbizepbdes. @KIL, 968(7).
EMAP. (?:90). @idihbid Wbews ad Zres`rbptbad Hrun @averine. Zress receise, Kiy ??, ?:90.
Evids, _. (?::6). _egark, _e-Gark, idh _ei`tbad bd tfe @idihbid Feictf @ire Pystek. Feictf Ciw
Laurdic, Ppe`bic Ehbtbad.
Evids, _. (?:90). @ad`cuhbdn _ekirms. Zresedtitbad it tfe sekbdir _etfbdmbdn Hrun @averine fech bdAttiwi, Kiy ?5, ?:90. fttp
-
7/27/2019 Call growing louder for national prescription drug plan
74/108
52
Obocbanripfy
Attiwi Ppedhs ?:9?-?:90, 00 (Peptekoer ?:9?), 979-9>?.
Nindad, K.-I. (?:9?`). Cibhe puocbque cbdhustrbe pfirki`eutbque quo`abse < ce leu ed viut-bc ci
`fidhecce1 Bdtervedtbads `adakbques/Zipers bd Zacbtb`ic E`adaky, 88 (Kiy ?:9?).
Nindad, K.-I. (?:9?h). Hrun Pfartines< Peir`fbdn gar i @ure. Feictf`ire Zacb`y, >(8), 9:-9>.
Nindad, K.-I. (?:9?e). Zitedt prate`tbad sfauch `ake it i prb`e. ^bddbpen Gree Zress, Iunust ?6, ?:9?.
Nindad, K.-I. (?:90). @arruptbad ag Zfirki`eutb`ic Kirmets< Ihhressbdn tfe Kbsicbndkedt ag Gbdid`bic
Bd`edtbves idh Zuocb` Feictf. ^armbdn Ziper gar tfe Ehkadh L. Pigri @edter gar Etfb`s, Firvirh
Udbversbty. fttp, ?:90.
Ntzs`fe, Z. (?:90). Heihcy Kehb`bdes idh Arnidbzeh @rbke. Cadhad< _ih`cbgge Zuocbsfbdn.
Nraatedharst, Z., Faccbs, I. (?:99). Kidinbdn Zfirki`eutb`ic Expedhbtures< Id Avervbew idh Aptbads
gar @idihi. Attiwi< @FP_G. fttp6-960.
Firhbdn, H. (?:9:). Nibdbdn Kirmet Pfire bd tfe Nederb` Hrun Bdhustry tfraunf I`qubsbtbads idh
Zirtdersfbps. Xfaksad _euters. fttp, ?:9?. fttp/hrunQsfartinesQ
sbdnceQsuppcberQgarQnederb`Qbdle`tiocesQitQraatQagQ`rbsbsQbdQ`idihi.ftkc
Merkahe-P`att, O. (?:90). @idihbid hrun sigety bdbtbitbve wbds ncaoic suppart bd `ikpibnd ta five
gudhbdn restareh. Orbtbsf Kehb`ic Laurdic, 08>.
Madhra, ^. (?:9?). Gar tfe _e`arh< Bts dat aur praocek, gehs siy ag hrun sfartine. @KIL, 968(6), 892-8?:.
-
7/27/2019 Call growing louder for national prescription drug plan
75/108
-
7/27/2019 Call growing louder for national prescription drug plan
76/108
-
7/27/2019 Call growing louder for national prescription drug plan
77/108
-
7/27/2019 Call growing louder for national prescription drug plan
78/108
70
Iddexes
Iddex 9
Zer `ipbti pravbd`bic virbitbads saur`es gar pres`rbptbad hruns `akpireh ta iverine
expedses per `ipbti bd tfe rest ag @idihi (_A@), Iprbc ?:9?-Kir`f ?:90
O@ IO PM KO AD Y@ DO DP ZEB DC
Zfirki`y hbspedseh
pres`rboeh hruns
expedses (kbccbad $)
$?,078 $?,?00 $797 $>:> $6,50? $7,79: $79: $>98 $25 $89:
Zravbd`bic per ipbti
expedses ($)$599.8 $5>7.8 $5>:.6 $556.9 $709.6 $6?:.7 $6:>.0 $>5?.8 $759.8 $6::.:
Zer `ipbti bd tfe _A@
($)$7>6.8 $777.0 $752.: $77:.: $7>9.6 $7:>.: $75?.2 $750.7 $757.0 $758.9
_A@ expedses
virbitbads per pravbd`bic`ipbti
-?8.7% -90.5% -90.8% -95.8% -7.:% 05.?% ?0.7% 95.9% -:.>% ??.0%
Wirbitbads oiseh ad
papucitbad ine0.7% -9:.>% -8.9% -8.0% -:.2% 8.0% 7.5% 7.6% 8.8% >.:%
Wirbitbads expedses
tatic per `ipbti
i``arhbdn ta
stidhirhbzeh ine
-?>.?% -0.9% -2.>% -99.>% -5.9% ?2.7% 97.9% >.6% -8.2% 98.?%
Wacuke egge`t -?0.?% -5.2% -9?.:% -6.>% -:.9% ?0.5% 95.8% 99.5% -9.9% 90.:%
Zres`rbptbad vacuke -8:.8% -0:.7% -9?.:% -92.2% -?0.5% 6:.0% -99.5% -??.>% -92.0% -6.?%
Pbze ag pres`rbptbads 9>.?% ?8.>% :.:% 99.?% ?0.0% -57.6% ?>.:% 08.?% 96.?% ?9.?%
Xferipeutb` fab`e
egge`t-8.>% :.>% -0.:% ->.0% 9.>% -9.7% -9.8% -?.8% -8.6% -5.2%
Xferipeutb` aptbad -0.7% 9.0% 9.5% -?.6% ?.:% -5.8% :.>% -:.5% -:.>% -?.5%
Kehb`bde aptbad -9.9% -:.7% -8.8% -8.5% -:.0% 0.2% -?.9% -9.2% -8.9% -0.8%
Zrb`e egge`t :.>% ?.9% 5.0% 8.8% -7.>% >.7% ?.:% -9.0% 9.:% >.9%
Zrb`es pibh :.6% 0.:% 5.5% 5.8% -5.2% 5.5% 0.0% -:.8% ?.9% 6.9%
Use ag nederb`s -:.9% -:.2% -:.?% -9.9% -:.>% ?.9% -9.0% -9.:% -9.9% -9.9%
Paur`e< Karnid et ic., ?:90
-
7/27/2019 Call growing louder for national prescription drug plan
79/108
-
7/27/2019 Call growing louder for national prescription drug plan
80/108
75
Iddexes
O_BXBPF @ACUKOBI (s`edirba 9)
Estbkitbad ag tfe `asts idh oedets nederiteh oy i udbversic pfirki`ire pranrik,
meepbdn tfe sike bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90nures
9. ?:9? pres`rbptbad hruns expedhbtures $?,609 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag urredt expedhbture
0. _ehu`tbad bd expedhbtures grak he`reise bd hbspedsbdn gees -?% ag `urredt expedhbture
8. _ehu`tbad bd expedhbtures grak hrun issesskedt -:% ag urredt expedhbture
5. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
7. Xedherbdn pra`ess gar nederb` hruns -$75 kbccbad
Xatic sivbdns ad pres`rbptbad hruns ($957 kbccbad)
Xatic pres`rbptbad hrun expedhbtures wbtf i udbversic pfirki`ire pcid $?,26> kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
>. Ecbkbditbad ag prbvite pcid extri ihkbdbstritbve asts -$906 kbccbad
6. Ecbkbditbad ag tix suosbhbes -$9?0 kbccbad
Xatic ihhbtbadic bkpi`ts -$?79 kbccbad
Xatic det sivbdns $9:5 kbccbad (8%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
81/108
7
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idO_BXBPF @ACUKOBI (s`edirba ?)
@ast idh sivbdns estbkitbads grak bkpcekedtitbad ag i udbversic pfirki`ire
pranrik wbtf repeic ag bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90 nures
9. ?:9? pres`rbptbad hruns expedhbtures $?,609 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
Pivbdns wbtf akpetbtbve obhhbdn -$9,:92 kbccbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag expedses
0. _ehu`tbad bd expedhbtures grak he`reise bd hbspedsbdn gees -?% ag expedses
8. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
Xatic sivbdns ad pres`rbptbad hruns -$6>6 kbccbad
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $9,250 kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
5. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$906 kbccbad
7. Ecbkbditbad ag tix suosbhbes -$9?0 kbccbad
Xatic ag ihhbtbadic bkpi`ts -$?79 kbccbad
Xatic det sivbdns $9,902 kbccbad (8:%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
82/108
7>
Iddexes
ICOE_XI (s`edirba 9)
Estbkitbad ag tfe `asts idh oedets nederiteh oy i udbversic pfirki`ire
pranrik, meepbdn tfe sike bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad?:9?-?:90 nures
9. ?:9? pres`rbptbad hruns expedhbtures $?,>55 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag urredt expedhbture
0. _ehu`tbad bd expedhbtures grak he reise bd hbspedsbdn gees -?% ag `urredt expedhbture
8. _ehu`tbad bd expedhbtures grak hrun issesskedt -8.6% ag urredt expedhbture
5. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
7.Xedherbdn pra`ess gar nederb` hruns -$78 kbccbad
Xatic sivbdns ad pres`rbptbad hruns ($5 kbccbad)
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $?,>7: kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
>. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$908 kbccbad
6. Ecbkbditbad ag tix suosbhbes -$992 kbccbad
Xatic ag ihhbtbadic bkpi`ts -$?50 kbccbad
Xatic det sivbdns $?86 kbccbad (2%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
83/108
-
7/27/2019 Call growing louder for national prescription drug plan
84/108
72
Iddexes
PIPMIX@FE^ID (s`edirba 9)
Estbkitbad ag tfe `asts idh oedets nederiteh oy i udbversic pfirki`ire pranrik,
meepbdn tfe sike bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90nures
9. ?:9? pres`rbptbad hruns expedhbtures $69: kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag urredt expedhbture
0. _ehu`tbad bd expedhbtures grak he`reise bd hbspedsbdn gees -?% ag `urredt expedhbture
8. _ehu`tbad bd expedhbtures grak hrun issesskedt -9.8% ag urredt expedhbture
5. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
7. Xedherbdn pra`ess gar nederb` hruns -$92 kbccbad
Xatic sivbdns ad pres`rbptbad hruns ($0? kbccbad)
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $68? kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
>. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$02 kbccbad
6. Ecbkbditbad ag tix suosbhbes -$05 kbccbad
Xatic ag ihhbtbadic bkpi`ts -$>8 kbccbad
Xatic det sivbdns $8? kbccbad (5%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
85/108
>
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idPIPMIX@FE^ID (s`edirba ?)
@ast idh sivbdns estbkitbads grak bkpcekedtitbad ag i udbversic pfirki`ire
pranrik wbtf repeic ag bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90 nures
9. ?:9? pres`rbptbad hruns expedhbtures $69: kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
Pivbdns wbtf akpetbtbve obhhbdn -$?66 kbccbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag expedses
0. _ehu`tbad bd expedhbtures grak he`reise bd hbspedsbdn gees -?% ag expedses
8. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
Xatic sivbdns ad pres`rbptbad hruns -$?8> kbccbad
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $570 kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
5. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$02 kbccbad
7. Ecbkbditbad ag tix suosbhbes -$05 kbccbad
Xatic ag ihhbtbadic bkpi`ts -$>8 kbccbad
Xatic det sivbdns $0?9 kbccbad (8:%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
86/108
>9
Iddexes
KIDBXAOI (s`edirba 9)
Estbkitbad ag tfe `asts idh oedets nederiteh oy i udbversic pfirki`ire pranrik,
meepbdn tfe sike bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90nures
9. ?:9? pres`rbptbad hruns expedhbtures $296 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag urredt expedhbture
0. _ehu`tbad bd expedhbtures grak he`reise bd hbspedsbdn gees -?% ag `urredt expedhbture
8. _ehu`tbad bd expedhbtures grak hrun issesskedt (?.6 % ag urredt expedhbture)
5. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
7. Xedherbdn pra`ess gar nederb` hruns -$?9 kbccbad
Xatic sivbdns ad pres`rbptbad hruns ($>2 kbccbad)
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $22> kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
>. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$85 kbccbad
6. Ecbkbditbad ag tix suosbhbes -$8: kbccbad
Xatic ag ihhbtbadic bkpi`ts -$65 kbccbad
Xatic det sivbdns $7 kbccbad (9%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
87/108
-
7/27/2019 Call growing louder for national prescription drug plan
88/108
-
7/27/2019 Call growing louder for national prescription drug plan
89/108
>
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idADXI_BA (s`edirba ?)
@ast idh sivbdns estbkitbads grak bkpcekedtitbad ag i udbversic pfirki`ire
pranrik wbtf repeic ag bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90 nures
9. ?:9? pres`rbptbad hruns expedhbtures $9:,78: kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
Pivbdns wbtf akpetbtbve obhhbdn -$0,6:2 kbccbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag expedses
0. _ehu`tbad bd expedhbtures grak he`reise bd hbspedsbdn gees -?% ag expedses
8. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
Xatic sivbdns ad pres`rbptbad hruns -$0,?>7 kbccbad
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $>,078 kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
5. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$596 kbccbad
7. Ecbkbditbad ag tix suosbhbes -$87? kbccbad
Xatic ag ihhbtbadic bkpi`ts -$26: kbccbad
Xatic det sivbdns $8,?57 kbccbad (8:%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
90/108
>5
Iddexes
YUOE@ (s`edirba 9)
Estbkitbad ag tfe `asts idh oedets nederiteh oy i udbversic pfirki`ire pranrik,
meepbdn tfe sike bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90nures
9. ?:9? pres`rbptbad hruns expedhbtures $>,852 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag urredt expedhbture
0. _ehu`tbad bd expedhbtures grak he reise bd hbspedsbdn gees -?% ag urredt expedhbture
8. _ehu`tbad bd expedhbtures grak hrun issesskedt -0.9% ag urredt expedhbture
5. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` -$078 kbccbad
7. Xedherbdn pra`ess gar nederb` hruns -$9>0 kbccbad
Xatic sivbdns ad pres`rbptbad hruns -$989 kbccbad
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $>,096 kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
>. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$070 kbccbad
6. Ecbkbditbad ag tix suosbhbes -$0?8 kbccbad
Xatic ag ihhbtbadic bkpi`ts -$76> kbccbad
Xatic det sivbdns $6?6 kbccbad (99%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
91/108
-
7/27/2019 Call growing louder for national prescription drug plan
92/108
-
7/27/2019 Call growing louder for national prescription drug plan
93/108
-
7/27/2019 Call growing louder for national prescription drug plan
94/108
>2
Iddexes
DAWI P@AXBI(s`edirba 9)
Estbkitbad ag tfe `asts idh oedets nederiteh oy i udbversic pfirki`ire pranrik,
meepbdn tfe sike bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90nures
9. ?:9? pres`rbptbad hruns expedhbtures $278 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag urredt expedhbture
0. _ehu`tbad bd expedhbtures grak he reise bd hbspedsbdn gees -?% ag urredt expedhbture
8. _ehu`tbad bd expedhbtures grak hrun issesskedt -?% ag urredt expedhbture
5. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
7. Xedherbdn pra`ess gar nederb` hruns -$?? kbccbad
Xatic sivbdns ad pres`rbptbad hruns ($0? kbccbad)
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $227 kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
>. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$8> kbccbad
6. Ecbkbditbad ag tix suosbhbes -$8? kbccbad
Xatic ag ihhbtbadic bkpi`ts -$62 kbccbad
Xatic det sivbdns $5> kbccbad (7%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
95/108
6
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idDAWI P@AXBI(s`edirba ?)
@ast idh sivbdns estbkitbads grak bkpcekedtitbad ag i udbversic pfirki`ire
pranrik wbtf repeic ag bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90 nures
9. ?:9? pres`rbptbad hruns expedhbtures $278 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
Pivbdns wbtf akpetbtbve obhhbdn -$08> kbccbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag expedses
0. _ehu`tbad bd expedhbtures grak he`reise bd hbspedsbdn gees -?% ag expedses
8. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
Xatic sivbdns ad pres`rbptbad hruns -$?22 kbccbad
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $775 kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
5. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$8> kbccbad
7. Ecbkbditbad ag tix suosbhbes -$8? kbccbad
Xatic ag ihhbtbadic bkpi`ts -$62 kbccbad
Xatic det sivbdns $066 kbccbad (8:%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
96/108
-
7/27/2019 Call growing louder for national prescription drug plan
97/108
-
7/27/2019 Call growing louder for national prescription drug plan
98/108
60
Iddexes
DE^GAUDHCIDH IDH CIO_IHA_(s`edirba 9)
Estbkitbad ag tfe `asts idh oedets nederiteh oy i udbversic pfirki`ire pranrik,
meepbdn tfe sike bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90nures
9. ?:9? pres`rbptbad hruns expedhbtures $825 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag urredt expedhbture
0. _ehu`tbad bd expedhbtures grak he`reise bd hbspedsbdn gees -?% ag `urredt expedhbture
8. _ehu`tbad bd expedhbtures grak hrun issesskedt (9.5% ag urredt expedhbture)
5. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
7. Xedherbdn pra`ess gar nederb` hruns -$9? kbccbad
Xatic sivbdns ad pres`rbptbad hruns ($05 kbccbad)
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $50: kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
>. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$?8 kbccbad
6. Ecbkbditbad ag tix suosbhbes -$?? kbccbad
Xatic ag ihhbtbadic bkpi`ts -$87 kbccbad
Xatic det sivbdns $99 kbccbad (?%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9:
-
7/27/2019 Call growing louder for national prescription drug plan
99/108
6
I_aihk
iptai_itb
ZfirkiireZacb`ybd@idDE^GAUDHCIDH IDH CIO_IHA_(s`edirba ?)
@ast idh sivbdns estbkitbads grak bkpcekedtitbad ag i udbversic pfirki`ire
pranrik wbtf repeic ag bdhustrbic pacb`bes issa`biteh ta hrun `asts, oiseh ad ?:9?-?:90 nures
9. ?:9? pres`rbptbad hruns expedhbtures $825 kbccbad
Icca`itbad ag `asts/revedues bd pres`rboeh kehb`itbad
Pivbdns wbtf akpetbtbve obhhbdn -$9>2 kbccbad
?. Bd`reise bd expedhbtures grak bd`reise bd use +9:% ag expedses
0. He`reise ag expedses grak hbspedsbdn gees rehu`tbads -?% ag expedses
8. Ecbkbditbad ag tfe kadtfcy hehu`tboce bd Yueoe` $: kbccbad
Xatic sivbdns ad pres`rbptbad hruns -$958 kbccbad
Xatic pres`rbptbad hruns expedses wbtf i udbversic pfirki`ire pcid $089 kbccbad
Ihhbtbadic bkpi`ts atfer tfid gar pres`rbptbad hruns
5. Ecbkbditbad ag extri ihkbdbstritbve asts oy prbvite pcids -$?8 kbccbad
7. Ecbkbditbad ag tix suosbhbes -$?? kbccbad
Xatic ag ihhbtbadic bkpi`ts -$87 kbccbad
Xatic det sivbdns $?:: kbccbad (8:%)
Paur`e< Iutfars nures= Nindad & Foert, ?:9: