Prescription drug deal breakdown

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As details emerge of the pharmaceutical industry’s agreement to kick in $80 billion to help pay for health care reform, the deal is facing increasing skepticism from inside and outside the health care industry.

The broad outlines of the proposal known since last week include $30 billion to help defray seniors’ drug costs and $50 billion to pay for reform. But POLITICO has learned from industry insiders that the $50 billion in savings will be broken down into four broad categories:

Medicaid: Drug companies will sell drugs at a bigger discount to the Medicaid program, increasing the discount rate from 15.1 percent to 23.1 percent off its average drug pricing. President Barack Obama’s budget called for increasing the rate to 22.1 percent at a cost of about $19.5 billion, but the extra percentage point and other modifications lawmakers are considering put the deal’s cost between $30 billion and $35 billion, industry insiders said.

Biogenerics: The industry has agreed to the creation of a federal approval process for generic biologics, drugs such as insulin that are proteins made by living organisms. And while important details have yet to be worked out – including how long name-brand drug makers should be allowed to exclusively sell biologics – the industry has agreed to a pathway for biogenerics that will cost them about $9 billion, according to the president’s budget.

Medicare: The industry will spend about $30 billion to pay for drug discounts to seniors who find themselves paying the full-price for drugs under Medicare.

Reform fee: And finally, drug companies will pay some kind of health care reform fee to cover any difference between the cost of the Medicare, Medicaid and biogenerics programs and the $80 billion the industry has committed to spending.

The $30 billion to help seniors pay for Medicare drugs does not count toward paying for reform, but is a major priority for Obama and many congressional Democrats. The $50 billion commitment will amount to real savings that can be counted by the Congressional Budget Office, the debate’s official scorekeeper, say some industry insiders and lawmakers.

But others are beginning to wonder just how much money the deal will actually save taxpayers. The questions are reminiscent of the $2 trillion in savings six major health industry groups recently promised to deliver to the administration, only to find that many of their savings proposals weren’t counted, or “scored” as savings by the CBO.

Still, Ken Johnson, a senior vice president at PhRMA, said, “When it’s all said and done, there will be significantly scorable savings for the federal government, but until CBO weighs in we’re playing checkers in the dark.”

There are also questions about how much goodwill PhRMA’s deal bought among Democrats, many of whom would like to see the industry contribute even more toward reform’s estimated $1 trillion price tag. Some Democrats, particularly in the House, have suggested using price controls and importation to rein in costs – ideas that are deal killers for drug makers.

“Most of us downtown would not be surprised if PhRMA continues to be in the sights of some pain here. This deal not being the end of the story,” said a health care industry insider.

Indeed, even those within the industry acknowledged that the fight was far from over.

“There will continue to be a number of outstanding issues everything from re-importation to biogenerics. But you do want to create some political goodwill. That’s just smart politics,” said a drug industry source. “At the end of the day, you want to be on the winning side of the scoreboard.”