“About 18 million Americans, or 7% of U.S. adults, say they were recently unable to pay for at least one prescription medication for their household, according to a new poll from Gallup and West Health”.

Democrats, Republicans, and Independents are struggling with health care costs, even if they are insured, as prescription drug prices continue to rise. No one should be forced to choose between filling their prescriptions or rent, gasoline, heat, or food.

However, what is not clear is whether our elected officials are choosing between the people they represent and the Big Pharma lobbyists who write checks to their campaigns.

President Biden’s Build Back Better Act includes provisions that could go a long way toward delivering on these long-promised drug reform policies. The new $35 cap on out-of-pocket costs for insulin for patients on commercial or Medicare insurance plans is a major step forward for vulnerable patients.

High drug prices have a disproportionate impact on sicker and poorer Americans. Almost one in 10 Americans with at least three chronic conditions said they had to skip purchasing a medication in the last three months, compared with about one in 25 people without any chronic conditions, according to one Gallup survey.  Skipping purchasing or rationing medication can be deadly. This was illustrated by NPR with the story of Nicole Smith-Holt, who lost her son three days before his next pay day because he couldn’t afford to fill his insulin prescription. The price of insulin, which has no generic equivalent, has more than doubled since 2012. Those who are most in need of prescription drugs are also the most likely to be negatively impacted by lack of access to affordable medicine. 

For minority communities, access to affordable insulin is an even bigger issue. Nearly one in five Black adults suffer from diabetes, a rate more than double the white patient population. The high cost of care also contributes to a higher death rate. Black Americans die at more than twice the rate of their counterparts from diabetes.

We’ve already seen the ugly health disparities in our system at the forefront of the COVID-19 pandemic, as patients of color have died at much higher rates than white people. Capping out-of-pocket costs will immediately benefit all patients, and especially those from the minority community who need the help the most.

The Build Back Better Act isn’t perfect, however, and some provisions could actually make drugs more expensive and less accessible. The inflation price rebate penalty sounds good – drug makers should not be allowed to increase their prices more than the rate of inflation. But it really only works for brand-name drugs, which have a government-protected monopoly. This allows companies making the most expensive medicines to set their prices as high as they’d like.

Generic drugmakers, in contrast, deal with far more price fluctuations and a more competitive market, which in turn drives costs down for consumers. And generic drug prices continue to get cheaper year over year, on average. Brand-name drug prices, meanwhile, continue to be “unsustainable, unjustifiable, and unfair,” according to a recent report from Congressional Democrats. So it makes no sense to penalize a generic drug costing $1 for increasing its price to $1.04, but to give a free pass to a Big Pharma company increasing the price of its $10,000 brand drug to $10,299. As written, that’s what the House version of the Build Back Better Act would do.

Fortunately, Sen. Michael Bennet and his colleagues on the Senate Finance Committee took notice and exempted generic drugs from the penalty. This is the right move, politically and, more importantly, morally.

Generic and bio-similar drugs account for 90% of prescriptions filled in the U.S., yet brand-name drugs account for 80% of the spending. For example, the osteoporosis drug Fosamax used to cost $2.60 per day, or $80 per month. Now, its generic version costs $0.28 per day, less than $9 per month. 

These savings, and the availability of lower-cost medicines, could be jeopardized by these new federal government policies if they are left un-amended. Lower-income and working-class families, and seniors living on fixed incomes, would be put at risk.

Sen. Bennet has shown time and again his willingness to learn complex policy, understand its long-term impacts, and make the necessary changes. The Biden White House should heed his leadership again and support the Senate version of the Build Back Better Act which makes the bill more patient friendly.

Elected officials have promised lower drug prices for a long, long time. To come so close, and then fall victim to unintended policy consequences thanks to Big Pharma’s powerful lobbying, would be a serious mistake.

Maya Wheeler is Executive Director of the African Chamber of Commerce, Colorado, and former chair of the African American Initiative of Colorado Democrats (AAICD) with the CO Democratic Party.