Moving forward to address prescription drug affordability
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The administration’s decision to withdraw a proposed regulation on prescription drug rebates recognized the risk of increasing premiums. They should be commended for being willing to consider that impact and to seek other ways forward. We all still must grapple with the challenge of addressing our country’s affordability problem with high cost prescription drugs.

As we’ve seen just this month, drug manufacturers continue to increase list prices on all kinds of medications, threatening patients and consumers with rising costs and diminishing access.

In the face of escalating drug prices, pharmacy benefit managers have achieved an overall stable cost trend for prescription drugs. Net prescription drug spending from 2016 to 2018 grew by only an annual average amount of 2 percent.


Even with this overall low-cost trend, there is no question that there is still a problem of affordability for consumers that must be addressed. Keeping premiums from increasing is important, but so is helping those facing high out-of-pocket costs.

So how do we address the affordability problem? We start by encouraging greater competition in the prescription drug marketplace, injecting transparency into the supply chain, and consider updating Part D to cap beneficiary costs and realign incentives.

Drug manufacturers’ abuse of the patent system can significantly delay far less costly generic and biosimilar launches in the U.S. market. Patent settlements, or pay-for-delay agreements, allow drug patent holders to pay off potential competitors who would otherwise produce a competing generic or biosimilar drug. These anticompetitive practices should be eliminated because they prevent the development of more choices for doctors and their patients and reduce negotiating leverage that can bring prices down. PCMA supports a number of legislative and regulatory policies to increase competition, and build on market-based tools that lower drug costs in public programs and private health insurance.

Greater transparency is important to understand and shine light on price increases. Transparency can also empower patients, which is why PBMs encourage the use of real-time benefit tools that allow a doctor and patient, at the point of prescribing, to be fully informed of the options and costs when choosing a drug for that patient’s care. And transparency can help empower employers and others offering prescription drug coverage so that they can structure their benefits in a way that meets the unique needs of their enrollees and allows them to choose for themselves how to utilize the savings that PBMs negotiate on their behalf.

Updating Medicare Part D is also an important piece of the puzzle, one that policymakers are actively considering. Changes to the program are promising but should be approached thoughtfully. Through Part D modernization, we can directly address out-of-pocket costs and align the program in a way that doesn’t incentivize drug companies to raise prices.

Ultimately, the proposed rebate rule had the right intention: to reduce prescription drug costs for consumers. We should all be working together to advance solutions to address drug affordability. PBMs are engaged and want to work with Congress and the administration to tackle this challenge.

J.C. Scott is president and CEO of Pharmaceutical Care Management Association.