No: Controlling drug prices keeps care more affordable for all

The pharmaceutical industry is extremely resourceful when it comes to pushing high-priced drugs in the health-care market. Industry representatives shower doctors with free samples of their priciest products to pass onto patients. Consumers are targeted by ads urging them to “ask your doctor” about this or that new treatment.

But when doctors prescribe the most expensive medicinal options, it affects not only their patients and their health plans, but also employers, taxpayers and the entire health-care system, which is plagued by perpetually increasing costs.

That’s why Medicare, Ohio Medicaid, private insurers and employers all have implemented something called step therapy. Step therapy is a sciencebased approach to help patients address their medical conditions with a safe, cost-effective therapy before that patient is prescribed a morecomplex, costlier, or riskier drug.

A recent study found that if state Medicaid programs used tools such as step therapy to help detect and avoid inappropriate use, $1.9 billion could be saved over the next 10 years.

The Congressional Budget Office has indicated that, in the absence of common techniques such as step therapy, premiums for plans would be 5 to 10 percent higher than current levels.

Considering the current trajectory of health-care costs, such an increase is unacceptable and unsustainable.

Out-of-control drug prices leave too many Ohioans to choose between paying their bills or paying for their medications. The problem is the price, driven by monopolies in a broken market that empower branded drugmakers to raise prices on the same products year after year. Increases in the cost of prescription-drug coverage dramatically impact the ability of many patients to obtain affordable health-care coverage, and threaten the ability of small employers to provide coverage for their employees.

Just two weeks ago, Pfizer announced it will increase the list prices of 41 of its medications by 5 percent beginning in January. From Epipens and naloxone to insulin and muscular dystrophy drugs, rising and erratic drug pricing has added to the overall cost of U.S. health care and placed undue burden and uncertainty on Ohioans.

Easing that burden is one benefit of step therapy, but not the only one. It also helps to keep patients safe, encouraging them to gauge their responses to less-dangerous drugs before transitioning them to more-potent medications. This is especially important at a time when Ohio is at the center of the nation’s opiate epidemic. Step-therapy protocols allow insurers to provide enhanced disease management while reducing the risk of overmedication or exposing patients to highly addictive drugs.

That’s not to say there are no flaws within step therapy. Some patients who have already gone through a step-therapy process to determine the proper medication for their needs are required to repeat the process if they switch health plans due to a new job or change in employer insurance. This is wrong and must be fixed.

That is why Ohio’s health plans have consistently advocated for state law that would protect patients from having to repeat step therapy if they switch plans.

We are optimistic the Ohio General Assembly will pass a bill that will accomplish this. But the legislation was almost sabotaged by other language in Senate Bill 56 that would have undermined the step-therapy process altogether, exposing Ohioans to higher drug costs.

The Pharmaceutical Research and Manufacturers of America aggressively pushed language that would have chipped away at step therapy by using a very broad exemption, making it easier for the industry to sell its most expensive drugs in Ohio — saddling Ohioans with the costs associated with those pricey drugs.

Thankfully, Ohio lawmakers pushed back on the drug lobby’s strategy and stripped out the exemption language in SB 56.

Unfortunately, however, this wasn’t PHRMA’S first effort to undercut the steptherapy process, and it won’t be the last.

All of us in the health-care system should fight to preserve step therapy because it protects patients while taking a step toward addressing a national crisis: the spiraling cost of health care.

Miranda Motter is president and CEO of Ohio Association of Health Plans.