Limiting patient choice is the wrong way to address high drug prices

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In its recent budget request to Congress, the Trump administration outlined several actions the federal government should take to address rising drug prices. The goal is laudable – and action is long overdue. Some of the administration’s ideas could make significant positive impacts to patients’ ability to access treatments, including proposals to reduce Part D out-of-pocket costs, pass drug rebate payments along to patients, and reduce pharmacy benefit managers (PBMs) consolidation. However, as prescribing physicians, we are concerned that several of the administration’s most prominent proposals would not only fail to lower drug prices, but also severely limit our Medicare patients’ access to critical therapies.

Among the administration’s proposals is a plan to consolidate certain physician-administered drugs covered under Medicare Part B into Part D. We know from current experience that Part D drug coverage is rife with problematic insurer practices that hurt patients and drive up costs, such as specialty drug tiers and prior authorization requirements. The negative effects of these practices will only be amplified if Part B drugs are moved into the Part D structure, due to the high cost of many Part B drugs and the fact that there are very few treatment options. Transitioning Part B drugs into Part D would not only make it more difficult for our patients to access the medications they need, but it would also be unlikely to save much money. Part B drug spending amounted to just 3 percent of total Medicare spending in 2015, while Part D prescription drugs accounted for nearly four and a half times more in annual spending.

{mosads}Another concerning proposal would seek to use cuts to physician reimbursement for drug costs as a way to incentivize doctors to prescribe less costly Part B drugs, as a means of lowering drug costs. While the specifics of the proposal are hazy, it is clear to us as prescribing doctors that the plan’s premise is flawed, because it assumes that less costly, equally effective options exist for patients living with rheumatic diseases or complex neurological conditions, and that they can easily switch to an alternative therapy.

Neither assumption is true for rheumatologists, neurologists, and the patients under our care. Medicare Part B therapy options for the treatment of conditions like rheumatoid arthritis and multiple sclerosis are extremely limited – with only a handful of options covered in each disease category – and all are similarly priced.

Additionally, the availability of an alternate therapy doesn’t mean that it will be equally safe and effective in treating rheumatology and neurology patients. Unlike generic drugs, the biologic infusion and injectable therapies covered under Medicare Part B are extremely complex, and each therapy interacts with different patients’ bodies in different ways. For example, it is common for a patient to respond well to one type of therapy, but experience adverse reactions – such as blurred vision, tremors, and memory problems – to another, even if it is in the same drug class. Other times, a patient’s immune system might stop responding to their medication after years of successful treatment, at which point different therapy options must be explored.

Further limiting therapy options based on a drug’s price, as the administration’s proposal seeks to do, is a dangerous experiment that targets the wrong part of the drug delivery chain and threatens our patients’ health and wellbeing. It also does nothing to address the high initial prices and year-over-year increases to the cost of obtaining these drugs that providers and patients alike have had to manage.

If the administration truly wants to lower drug prices, it should promote policies that expand – not limit – competition and choice. Regulatory policy should support expedited FDA approval of new biosimilar therapies, which will increase competition and drive down prices. The administration should also work with Congress to increase transparency in the drug supply chain. Steps should be taken to ensure that rebates negotiated by PBMs are not incentivizing higher drug prices to cover the cost of these rebates while making it difficult for therapy options with lower costs to be offered on formularies due to lower profitability for PBMs. Any cost reductions should also be passed down as savings to consumers – as the administration has rightfully proposed. Lowering the price of a drug does no good if patients continue to pay the same price for it.

As the administration and Congress take on the sizable task of solving America’s drug pricing problem, we urge our nation’s leaders to support proposals that increase choice and competition – and abandon those that limit patient access to vital drugs. Doing so will ensure Medicare beneficiaries continue to receive the innovative and high-quality care they need and deserve.

David I. Daikh, MD, PhD, is President of the American College of Rheumatology. Ralph L. Sacco, MD, MS, FAHA, FAAN, is President of the American Academy of Neurology.


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