STICKER SHOCK ON PILLS
Need to bring down prices is clear, despite disagreements on solutions
Few argue that the cost of prescription drugs is a huge and growing problem, but finding an answer is proving to be a major challenge.
Elected officials and medical professionals are united in their concerns about escalating prescription drug prices. But consensus eludes many proposals to reverse the trend.
In what is billed as the latest attempt to tackle rising costs, President Donald Trump unveiled last week what he described as a sweeping proposal that would inject more choice and competition into the procurement and delivery of drugs. The American Patients First initiative has drawn mixed reactions, but many observers said it has, at the least, helped to shed more light on a major probinherently lem afflicting the U.S. health care system.
“The current path we’re on with drug prices is absolutely unsustainable,” said Dr. Jeff Gordon, a Waterford-based blood and cancer specialist, who is also the immediate past president of the Connecticut State Medical Society. “If we don’t deal with it now, it will be even worse to deal with later.”
Grappling with costs
Between 2013 and 2017, average undiscounted pharmacy prices for branded pharmaceutical drugs rocketed up by 58 percent, to about $364, according to data from health care analytics firm Iqvia.
In the same period, however, average out-of-pocket costs for prescription drugs of all types declined by 15 percent, to $8.69. The trend reflected greater use of generic drugs and coupons.
“There are coupons, which provide a benefit to the patients, but somebody is still paying for those drugs,” said Marghie Giuliano, CEO of the Connecticut Pharmacists Association. There’s something wrong with our system when these drugs are so expensive in the first place.”
Meanwhile, rising deductibles, and the growing percentage of workers who have them, are arguably limiting the use of products when patients have high cost exposure, the report said.
In a May 11 speech announcing the plan, Trump
said his proposal would combat rising prices through “tougher negotiation, more competition and much lower prices at the pharmacy counter.”
Pharmaceutical giant Boehringer Ingelheim, which makes drugs for conditions such as lung cancer, diabetes and pulmonary fibrosis and whose U.S. subsidiary is based in Ridgefield, said the proposal recognized the complexity of drug delivery. But the company also expressed misgivings.
“While we believe that some of these proposals could help make medicines more affordable for patients, we are concerned that others would disrupt coverage and limit patients’ access to innovative treatments,” the company said in a statement.
Trump also said his
proposal would give Medicare Part D plans “new tools to negotiate lower prices for more drugs, and make sure that Part D incentives encourage drug companies to keep prices low.”
Congressional Democrats pilloried Trump’s plan. Some of them accused the president of abandoning a campaign promise to enact direct negotiations for Medicare-covered drugs.
“There’s a reason why drug company (stock) profits skyrocketed the day President Trump made his prescription drug announcement,” U.S. Sen. Chris Murphy, D-Connecticut, a member of the Senate’s Health, Education, Labor and Pensions Committee, said in an email. “They know it’s just window dressing and it won’t do anything to reduce costs. Ultimately, we know what to do. Direct negotiation with Medicare beneficiaries is the best way to
lower prescription drug costs, and I’ll continue to fight for that.”
Doctors such as Gordon cite opacity about drug pricing as one of their greatest frustrations. He said he generally does not know the full cost of medicines he prescribes until patients fill them. Pharmaceutical companies do not readily share pricing details, he said.
“I think the transparency from those companies is low,” Gordon said. “There are ways to improve transparency without compromising companies’ proprietary information. It’s legitimate to know how much it’s costing to make the drugs, the profit margins and what is happening with the middlemen.”
Among measures in his plan to support greater sharing of information, Trump said it would ban “gag rule” regulations that pharmacists from advising patients how to save money.
“This is a total rip-off, and we are ending it,” Trump said.
In Connecticut, the state Legislature last year passed legislation prohibiting gag clauses. But the reform’s impact was limited because of federal laws that preempt state laws for selfinsurers, a group that includes most Connecticut companies, Giuliano said.
“We could produce significant savings by implementing a payment model in which pharmacists could use their clinical drug knowledge to ensure patients are getting the most appropriate medications,” Giuliano said.
Officials at Boehringer Ingelheim said they are trying to increase transparency and bring down costs through value-based contracts, which tie prices to patient outcomes. Sometimes the clinical outcome
is measured; other times the metric is total treatment costs.
The company said it has entered into such pacts with “health plans of various types, across many therapeutic areas.”
“Our goal at Boehringer Ingelheim is that no patient be denied access to our medicines because of cost,” the company said in its statement. “We are committed to doing the right thing for our patients, many of whom suffer from multiple chronic conditions. We are committed to ensuring patients have affordable access to all of our medicines.”
Decline in opioids
Lower drug prices likely would not significantly affect prescribing rates for opioids such as Stamfordbased Purdue Pharma’s top seller, OxyContin.
Prescription opioid volume peaked in 2011 at 240 billion milligrams of morblock phine equivalents and then declined by 29 percent, to 171 billion, in 2017, according to the Iqvia report. Last year represented the largest single-year change, with a 12 percent drop.
Purdue officials were not available to comment.
Declining opioid prescriptions reflect regulatory and reimbursement policies and legislation enacted since 2012 that have increasingly restricted opioid use, the report said.
“I haven’t seen anything where the cost of the opioids has been going up, and that’s been used to cut down on prescribing,” Gordon said. “The real reason prescribing has been going down is there’s been a lot more effort in the medical community about the right and wrong ways to prescribe opioids and greater education among patients.”