Drug­mak­ers coun­ter­at­tack over cost-shar­ing

Modern Healthcare - - NEWS - By Paul Demko

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.”

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