Drugmakers counterattack over cost-sharing

The drug industry is fighting back in an escalating battle between two Washington lobbying titans. After weeks of rhetorical beatings over the humongous cost of hepatitis C drug Sovaldi, drugmakers released a study last week documenting high patient cost-sharing for drugs in health plans sold through the Obamacare exchanges.

The study, conducted by Avalere Health on behalf of Pharmaceutical Research and Manufacturers of America, looked at drug formularies in 123 silver-tier plans, covering the largest city in every state. It found that a fifth of the plans required cost-sharing of at least 40% for some specialty drugs used to treat multiple sclerosis, cancer, HIV/AIDS and other illnesses.

John Castellani, CEO of PhRMA, called on HHS to limit exchange customers’ out-of-pocket drug costs. He said the report shows that “many Americans still find themselves unable to access the care they desperately need due to high out-of-pocket costs.”

Carl Schmid, deputy executive director of the AIDS Institute, said some HIV patients with plans purchased through the exchanges are skipping drug treatments because they can’t afford the cost. “Drugs are paramount to HIV care,” he said.

The broadside against insurers came less than a month after Karen Ignagni, head of America’s Health Insurance Plans, blasted drugmakers at a forum. Ignagni hinted that government price controls could be coming if the industry doesn’t exercise price restraint.

Last month, the National Coalition on Health Care announced a campaign to raise awareness of “unsustainable and abusive” drug prices. John Rother, the group’s CEO, said the coalition wants a national dialogue about high drug costs and is more in sync with the insurers’ position. “Trying to cast the problem as higher copays kind of ignores the fundamental issue, which is the price,” he said.

Both sides are well-armed for a political showdown. PhRMA spent more than $25 million on lobbying last year, according to a database maintained by the U.S. Senate, while AHIP spent $11.5 million.

“It is always of interest to see two giants go after each other,” said Judith Feder, a professor of public policy at Georgetown University. “It doesn’t seem that either one is shy about or limited in its ability to protect their industry’s interests.”