As Congress continues to examine the issue of drug pricing, there is one thing we can all agree on: drug prices are too high. A recent poll shows 80 percent of Americans want to see Congress and the Administration take action to reduce the burden of high and rising prescription drug prices on American families. After all, life-saving prescription drugs cannot help patients who cannot afford them.
At the root of the crisis are the high prices drug companies set for medicines. We have seen 2019 begin in much the same way as 2018 and years before that: with hundreds of price hikes from prescription drug companies. Did companies raise prices because the products were materially improved over the course of that year? Or in the month between December and January? The simple answer is no.
Amid this reality, it is time for Congress to implement practical policies that prevent pharma from artificially raising prices and support a competitive marketplace and increase access and affordability for patients.
In 2018, the Administration and Congress took steps to strengthen the prescription drug marketplace by closing loopholes and putting an end to harmful practices that stifle competition in the system. These positive gains included: the implementation of cost-saving step therapy in Medicare Part B; a proposal that would require Part D plan sponsors to use digital health tools to provide information on out-of-pocket costs in real time; and a provision to limit drug companies from gaming the system in the Part D protected classes.
Moving forward, CAPD sees a variety of ways the Administration and Congress can continue positive forward momentum to help lower the costs paid by patients at the pharmacy counter. Chief among them are:
Easing patient out-of-pocket costs: More than 22 million Americans have high deductible health plans with health savings accounts. These plans usually mean patients must pay for costly medications out-of-pocket until they reach their deductible. We support changes that would allow patients to have zero copay on medicines that treat chronic conditions and slow the progression of disease prior to meeting their deductible. In addition, we support expanding access to patient-specific cost information to consumers and providers at the time of prescribing. Both solutions would increase adherence, leading to improved health outcomes and decreased costs across the system.
Paying for value and increasing generic utilization in Medicare Part D: Incentivizing plan sponsors to voluntarily engage in outcomes-based contracting and bundled payment demonstrations would help ensure that payments are based on value brought by the therapies. Additionally, recent data has demonstrated the underutilization of generics in Medicare Part D is costing patients and taxpayers. The Administration should seek opportunities to encourage higher uptake of therapeutically equivalent generics such as increasing the brand/generic copay differential in the low-income subsidy (LIS) population as well as other options at the pharmacy counter.
Ending Pharma’s gamesmanship: For too long, drug companies have been allowed to distort the marketplace and keep prescription drug prices artificially high. They do this by continually seeking to block brand and generic competition. We support the prompt assertion of patents, allowing biosimilar manufacturers to resolve all patent issues prior to approval, and preventing restricted access programs from delaying timely generic competition.
As we move forward in 2019, we call on elected officials and policymakers to build on efforts to bring affordable treatments to Americans. Real solutions ease the cost burden on patients and payers and end market distortions and gamesmanship by drug companies.
The time to act is now.