Need to bring down prices is clear, de­spite dis­agree­ments on so­lu­tions

Stamford Advocate (Sunday) - - Front Page - By Paul Schott

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.”

Enough trans­parency?

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.”

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