“The ACR has prioritized this issue and has grave concerns regarding reduced patient access to care as a consequence of the administration’s drug pricing proposal,” says Colin Edgerton, MD, chair of the ACR’s Committee on Rheumatologic Care (CORC).
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Explore This IssueJuly 2018
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The principles underscore the importance of patient access to affordable, high-quality drugs. The ACR listed five key principles to ensure such access:
- Provide patients access to high-quality rheumatology treatments to control disease activity and prevent disability, permanent damage to joints and other organ systems, and early death;
- Reduce and streamline utilization management tools used in the drug distribution system, including Medicare Part D, which delay and prevent patients from accessing medicines;
- Ensure patients’ safe access to Medicare Part B treatments in monitored settings;
- Promote the use of treatment guidelines, when available, adapted for individualized treatment decisions made by doctors and patients; and
- Improve the FDA’s capacity and manufacturers’ ability to bring safe, effective biosimilars to market to maximize access to treatment by lowering costs.
In the American Patients First Drug Pricing Blueprint issued in May, the Trump administration laid out a number of questions on how to lower U.S. drug prices.2 According to Angus Worthing, MD, the ACR’s Government Affairs Committee chair, the blueprint identifies four problems and four solutions.
The four problems:
- High list prices;
- Government programs overpaying because they lack negotiation tools;
- High out-of-pocket costs; and
- Foreign free-riding.
The four solutions:
- Improved competition;
- Better negotiation;
- Incentives for lower list prices; and
- Lower out-of-pocket costs.
“There are some good ideas here and some possibly bad,” says Dr. Worthing, “It is clear that, in some way, rheumatology could be changed by these proposals, which is why the ACR will continue to respond vigorously.”
Good & Bad Ideas
One possible good idea, according to Dr. Worthing, is forcing payers to pass negotiated drug savings on to patients. One provision in the blueprint allows insurers and pharmacy benefit managers (PBMs) under Medicare Part D to share more of the rebates they get from pharmaceutical companies to patients.
That said, another provision in the blueprint, which allows private insurers more negotiating power on drugs delivered to a doctor’s office or hospital through Medicare Part B, may potentially be a bad idea, he says. The provision could result in “inserting step therapy and other utilization management techniques into Medicare Part B [physician-administered] drugs into the Part D system, restricting Medicare drug formularies by allowing payers to approve one drug [instead of two] per class, and recreating a competitive acquisition program for Part B drugs that was previously unworkable,” he says.