Drug Cost

What’s missing in the current drug pricing plan

Last week, a congressional forum looked at the role pharmacy benefit managers (PBMs) play in determining what patients pay out of pocket for prescription medicines. The forum provided an important reminder of how these middlemen operate in an opaque system that often leaves patients paying far more than they should for medicines. And it’s also …

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ICYMI: PhRMA CEO speaks at STAT Summit about government price setting

As part of the annual STAT Summit, PhRMA President and CEO Stephen J. Ubl recently spoke with STAT’s Matthew Herper to discuss the many unintended consequences expected from the latest drug pricing plan on Capitol Hill, as well as the biopharmaceutical industry’s plans to help build a better health care system that improves patient access …

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In the current health care debate, Congress has lost sight of what matters to U.S. voters

For months Congress has been debating massive changes to the nation’s social safety net, one of which is the highly popular Medicare prescription drug benefit. Unfortunately, much of what is being debated around that benefit today loses sight of the real barriers to a better health care system. It is a fact that too often, …

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Ask About Adherence: CMS finds medication adherence saved Medicare up to $46.6B in avoided health care costs between 2013 and 2018

A recent Centers for Medicare & Medicaid Services (CMS) study found that medication use is improving among seniors and vulnerable beneficiary populations. Better adherence to medicines used to treat common chronic conditions such as high cholesterol, high blood pressure and diabetes is estimated to have saved the Medicare program between $27B and $46.6B in avoided health care …

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ICYMI: New study confirms policies like H.R. 3 could significantly reduce drug development

A new study from economists at the University of Chicago examined the impact that government price-setting policies for medicines, like those in H.R. 3, could have if implemented. The economists found that a policy like H.R. 3 could reduce investment in the research and development (R&D) of new medicines by up to 60% between 2021 …

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New poll shows Americans reject Medicare “negotiation” once they learn more about the policy

As the debate in Washington around drug pricing proposals continues to intensify, a new Ipsos/PhRMA poll shows Medicare “negotiation” is not nearly as popular as some might suggest. Survey findings show that public opinion dips by nearly 50 points, overall, when Americans are presented with information both in support of and against Medicare “negotiations.”

New report: To drive up profits, hospitals continue unnecessary medicine mark-ups, burdening patients, employers and the health system

A new study from the Employee Benefit Research Institute (EBRI) compared the difference in price for 72 physician-administered outpatient medicines – representing 73% of medicine spending – depending on whether they were administered at a hospital outpatient department or physician’s office. Not surprisingly, EBRI found employers and plans paid hospitals significantly more than physicians for the …

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What is Kaiser Family Foundation up to?

For years, Kaiser Family Foundation (Kaiser) has reminded lawmakers that Americans are opposed to government “negotiation” in drug pricing should it lead to less access to medicines and destroy future innovation. Sadly, in a new poll, Kaiser is joining the partisan fray and political advocacy groups who are trying desperately to build congressional support for …

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Recognizing Hepatitis R&D on World Hepatitis Day

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, with types A, B, C most common. In 2018, the Centers for Disease Control and Prevention estimated that Americans were infected with 24,900 cases of hepatitis A and 21,600 cases of hepatitis B, many of …

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How strengthening the biosimilar marketplace benefits patients

Biologics are medicines that are made from living organisms through highly complex manufacturing processes and include a wide variety of medicines such as therapeutic proteins, monoclonal antibodies and vaccines. They are used to prevent or treat a variety of diseases including cancer, chronic kidney disease, diabetes, cystic fibrosis and autoimmune disorders.  

New report demonstrates development of new medicines relies on private sector expertise and investment

America’s biopharmaceutical companies are at the heart of a research and development (R&D) ecosystem that develops more innovative medicines than any other country in the world. Critical to this ecosystem is the working relationship between industry and government agencies like the National Institutes of Health (NIH), academic medical centers and community-based research sites to further …

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Top five issues voters want addressed in the administration’s first 100 days

When voters cast their ballots in the 2020 election, they made clear their focus on getting COVID-19 under control and fixing the economy. However, health care was still important to many voters, and in our review of public and PhRMA’s national and “state battleground” exit polling, we learned voters were most worried about protecting pre-existing …

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Insurers shift medicine costs to patients with severe chronic illnesses

For many patients with complex and chronic conditions, high out-of-pocket costs for medicines pose a significant challenge. Recent research revealed a broken insurance system that fails to help those who need care most. New resources further demonstrate how patients with asthma, diabetes, HIV and cancer can face high out-of-pocket costs due to insurance design.

Research shows gene therapies can offer cost savings potential of up to $1.8M over five years for patients with certain blood diseases

A recent analysis by Health Advances looks at two particularly burdensome hematological (or blood) diseases — beta thalassemia and hemophilia A — and finds that potential gene therapies in the pipeline could reduce per patient costs by as much as 41% and 90%, respectively, over five years. Research-based knowledge gained in recent years about the genetic …

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Accumulator adjustment programs lead to surprise out-of-pocket costs and nonadherence, analysis finds

A new analysis by IQVIA looked at three cost-sharing assistance programs and found that from 2018 to 2020, 25% to 36% of patients discontinued treatment when they faced an unexpectedly high out-of-pocket cost of $1,500 or more in the middle of the plan year. These unexpected costs were caused by accumulator adjustment programs operated by …

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Survey found insurance premiums grew faster than inflation in 2020

According to Kaiser Family Foundation’s recent survey on employer health benefits, premiums for people with employer-sponsored health insurance increased by 4% last year, faster than both the rate of wage growth and inflation. During this same time, prices for brand medicines increased just 1.7% after accounting for rebates and discounts, less than the rate of …

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Manufacturer cost-sharing assistance programs can save chronically ill patients hundreds to thousands of dollars annually

A recent analysis by IQVIA shows that chronically ill patients who used manufacturer cost-sharing assistance in 2019 saved hundreds to thousands of dollars on their out-of-pocket costs. IQVIA found that nearly one-third of commercially insured patients taking brand anticoagulants, diabetes or oncology medicines used manufacturer assistance to help pay their cost sharing for one or …

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Commercial health plans have increased patients’ out-of-pocket costs by over 50% in some therapeutic areas

According to a recent IQVIA analysis, commercial health plans have increased patients’ average out-of-pocket costs for brand medicines by over 50% in some therapeutic areas since 2015. Notably, of the seven therapeutic areas that IQVIA analyzed, including anticoagulants, asthma/COPD, depression, diabetes, HIV, multiple sclerosis and oncology treatments, average patient cost exposure between 2015 and 2019 …

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Commercial health plans’ transition from copays to coinsurance and deductibles has increased patient out-of-pocket costs for brand medicines

A decade ago, most patients paid only copays for brand medicines. But in recent years, use of deductibles and coinsurance in commercial health plans has skyrocketed. According to a recent IQVIA analysis, commercially-insured patients now pay most of their out-of-pocket spending for brand medicines in the form of deductibles and coinsurance. For five of seven …

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Four things to know about the IQVIA “Medicine Spending and Affordability in the U.S.” report

Today, IQVIA released a new report, Medicine Spending and Affordability in the U.S., providing context on medicine price and spending trends and patient out-of-pocket costs. The report highlights an alarming trend where health plans increasingly use deductibles and coinsurance to shift more of the cost of care to chronically ill patients taking brand medicines. This is …

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New data show commercially insured patients face increasingly high cost sharing for brand medicines

New data show deductibles and coinsurance result in high out-of-pocket spending for commercially insured patients taking brand medicines. IQVIA analyzed trends in cost sharing across seven therapy areas and found that anywhere from 44% to 95% of patients’ total out-of-pocket spending for brand medicines in 2019 was due to deductibles and coinsurance. Compared to patients …

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Payers subject 80% of new RA and MS patients to utilization management restrictions

A new analysis from IQVIA shows that in 2018, 80% of commercially insured patients attempting to fill a new prescription for a rheumatoid arthritis (RA) or multiple sclerosis (MS) medicine encountered a utilization management restriction. Of those patients, 3 out of 10 were unable to gain approval from their commercial market health plan to start …

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