Misuse of asthma and allergy medicine can be directly linked to price

Misuse of asthma and allergy medicine can be directly linked to price
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For people living with asthma and allergies, properly managing these conditions can drastically improve their quality of life. A key tool for patients is prescription medications that can help limit the disruptions associated with asthma and allergy complications. Unfortunately, the high cost of drugs and a complex and arcane rebate distribution system between prescription drug manufacturers and pharmacy benefit managers (PBMs) who work on behalf of health insurance companies stand in the way of improving the lives of patients.

This has real, tangible costs not only for individuals living with asthma and allergies, but for all patients.

Let’s zero in on just asthma for a moment. According to the Centers for Disease Control and Prevention (CDC), more than 26 million Americans have asthma. Asthma accounts for 14.2 million doctor’s office visits, 439,000 discharges from hospital inpatient care and 1.8 million emergency department visits each year. Annually, asthma accounts for $50.3 billion in medical costs with the average cost for patients totaling $3,266 each year.

High costs of treatments can drive patients toward negative health outcomes. Many patients with asthma do not properly follow their inhaled medication regimen. When asked why they aren’t taking their medicines as prescribed, the top three reasons cited centered around cost. Medication non-adherence driven by lack of access or cost concerns is directly linked to increased hospitalization rates and other complications. People with severe uncontrolled asthma report missing 10 or more days of work per year due to asthma complications.

Fortunately, we can begin to address costs and access issues by bringing renewed scrutiny, accountability and transparency into a system that fundamentally lacks all three. Congress recently held hearings with the CEOs of the five largest drug manufacturers to focus on the high cost of drugs. Now, a recent proposed rule change by the Department of Health and Human Services would mandate negotiated rebates in the Medicare Part D program to go directly to patients. By imposing the threat of penalties for manufacturers, PBMs and health plans seeking to keep these rebates for profit, patients may begin to see some much-needed relief at the pharmacy for their out-of-pocket obligations.

Consider this for a moment, 7.4 percent of Americans or 3.53 million people 65 years or older have asthma. These Part D beneficiaries could see an estimated 50 percent average total list-to-net discount on brand asthma and chronic obstructive pulmonary disease (COPD) medications if this rule goes into effect. For bronchodilators and corticosteroids that discount is estimated to be even higher. This could have a considerable impact on the budgets of seniors living with asthma. Additionally, because of Medicare Part D’s outsized place in the prescription drug market, changes to the program typically reverberate across the health care system, improving the lives of all patients in the process.

Patients living with chronic conditions like asthma and allergies are calling out for help from our elected leaders. They need a system that prioritizes individual health care concerns, while delivering value and high-quality treatment. The status-quo is entirely unsustainable, and good faith efforts from both sides of the aisle should be applauded for bringing transparency to our health care system.

We understand the cost concerns facing patients. We know that reforming our current rebate system to start working on behalf of patients would begin to address these issues. All we need now is action.

Kenneth Mendez is president and CEO of the Asthma and Allergy Foundation of America. AAFA is the oldest and largest nonprofit organization dedicated to improving the quality of life for people with asthma and allergies.