When it comes to healthcare, look at the larger picture

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In medical school, one of my mentors, the legendary surgeon Dr. LaSalle D. Leffall, Jr., taught us the importance of “equanimity under duress”—the ability to look calmly at the larger picture and not rush to judgment even when pressured to do so. This is critical counsel in medicine, but it’s also sound advice for our nation’s policymakers as they forge the future of American healthcare. Quality healthcare is highly personal to each of us, but the healthcare system is also extremely complex—and interconnected. A myopic focus on one element risks damaging the entire system for today’s patients as well as those who will someday be in need.

Recently, there has been a great deal of discussion about the price of medicines. As Chief Medical Officer of a biopharmaceutical company as well as “Chief Caregiver” for a family spanning four generations, I understand these concerns. Unlike with other healthcare services, such as doctors’ visits and hospitalizations, Americans are asked to pay a significant percentage of the cost of their prescriptions at the point of care.

{mosads}For example, a patient may see a modest co-pay for several thousand dollars’ worth of heart tests, but face multiple co-pays, month after month, for the medicines needed to treat or prevent heart disease.

Patients frequently face the greatest access challenges when prescribed new, innovative products. In recent years, the advent of precision medicine has revolutionized healthcare and offered new hope to millions of patients with life-threatening illnesses. Cancer, for example, isn’t one disease, but hundreds, and biopharmaceutical companies are targeting these variants with increasing precision.

Each of these specialized therapies has to be developed and thoroughly tested in a process that takes years and is fraught with risk. If a new drug results, the price of that treatment reflects the value of the innovation as compared to other treatment options when they exist, and price is negotiated in a highly competitive market with health plans. Then over time, medicines go off patent and costs generally come down; 90 percent of the prescriptions filled in the United States today are for generics, which typically cost significantly less than more recently introduced medicines. For example atorvastatin, known in the branded form as Lipitor, is 95 percent less than it was in 2010.

These are real challenges, and it is important for all of us to heed Dr. Leffall’s lesson. Policymakers often talk about drugs (and drug pricing) in a vacuum, with little recognition of the effects of successful therapies on patients and society at large.

Medicines that achieve their therapeutic goals mean less in the way of pain, disability and premature death. Importantly, they also result in savings in other parts of the health care system and society at large, including increased worker productivity and fewer dollars spent in the more costly arenas of healthcare—emergency rooms, hospital beds, and surgical suites. Prescription drugs account for about 13 percent of the nation’s health care bill. Hospitalization and physician services, by contrast, are more than half of U.S. health spending.

There is broad bipartisan agreement that health care should concentrate on patient outcomes and on the value added by each actor or element in the system. Drugs should be no exception.

Policymakers should look to encourage payment models that incorporate patient viewpoints, promote new ideas, stimulate competition, reward proven innovation, and foster investment in areas of unmet need – including therapies to treat the thousands of disease states for which there are no treatments. We must also make certain that patients are able to access the treatments they are prescribed, which means providing relief from discriminatory insurance benefit designs that put high-value pharmaceuticals out of reach.

All this comes with the understanding that we in the research-based biopharmaceutical industry must continue to live up to our obligations. We have greatly increased transparency and reformed marketing practices over the past decade, but there is more work to be done. We have expanded our programs that help those who are not insured and cannot afford their medicines. And we must work harder to explain in clearer detail the value of our therapies and how they are priced.

Those of us in the biopharmaceutical industry continue to be inspired by patients and proud of the value our therapies provide. Rather than perpetuating the “silos” that have served as barriers to innovation and care coordination, we ask that policymakers bring both broad vision and a measure of “equanimity under duress” to further reform. Keeping the patient at the center of care, and rewarding products and services for the value they provide, will go a long way to forging the type of healthcare system that Americans can be proud of—and that America can afford.

Freda Lewis-Hall, MD, is executive vice president and chief medical officer of Pfizer Inc.

The views expressed by authors are their own and not the views of The Hill.

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