Most rheumatology providers are familiar with the frustrating situation where, after spending months or even years trying to stabilize a patient’s autoimmune disease and find a treatment that really works for them, they’re confronted with figuring out how a patient will develop The problem of being able to afford their medicines. We are encouraged that President Biden acknowledged these challenges in his State of the Union address. By renewing his call on lawmakers to rein in high drug prices, President Biden has taken a hard line on behalf of the more than 54 million Americans with rheumatism.
Even with good insurance coverage, sky-high drug prices make treatment unaffordable for many of our patients. In 2019, A survey conducted by the American College of Rheumatology (ACR) People with rheumatism found that patients had a median out-of-pocket cost of $475 per year. one year later, Subsequent patient surveys It was found that reported out-of-pocket costs more than doubled to $1,000 per year. More than a quarter of patients have out-of-pocket costs of more than $2,000 per year.
High drug prices are also a major factor in rising insurance premiums, cost-sharing and deductibles.This additional financial burden is related to Patients who delay caregiving up or giving up treatment altogether – which can lead to flare-ups, disease regression, permanent disability, and even premature death.
Ultimately, high drug prices directly hurt our patients. Therefore, it is the responsibility of all suppliers to continue to advocate for reforms to control these costs. ACR’s 2022 Health Policy Statement Elucidating a range of potential solutions that will meaningfully reduce drug costs for patients and reduce associated barriers to treatment access.
First, the ACR supports policies that limit patient out-of-pocket costs. The Build Back Better Act proposes a cap on monthly cost-sharing for Medicare Part D beneficiaries and an annual cap on all out-of-pocket drug costs. These policies will go a long way in ensuring that those who need special medicines can afford them.
Second, policymakers must control pharmacy benefit managers (PBMs), their practices Exaggerated drug list prices And expose patients to higher co-pays and cost-sharing — creating unnecessary and progressive barriers to access to treatment in the first place. As middlemen working on behalf of insurance companies, PBMs earn additional profits from savings they should pass on to patients. Insurers who contract with and often have PBMs then turn around and put barriers to entry in the form of prior authorization and step-by-step treatment requirements.
nearly half 2020 survey respondents Reports required prior authorization to receive treatment, or were forced to attempt medication other than those prescribed to them prior to receiving prescribed treatment.These practices place insurance bureaucrats between patients and physician-prescribed treatments, with delayed care This leads to worse health outcomes.
Finally, policymakers should allow Medicare to negotiate drug prices with drug companies. The United States is the only country in the developed world that cannot negotiate prices directly with manufacturers. Without generic or biosimilar competition, manufacturers have little incentive to lower prices over time, and in fact, prices tend to rise far faster each year than inflation.
To ensure that Medicare price negotiations create real savings and greater opportunities for our patients, they must be implemented in a way that reduces real costs price drugs, rather than simply reducing reimbursement for providers who deliver drugs to patients. Past proposals, such as the Trump administration’s most-favored-nation model, would slash reimbursement for specialists administering Part B treatments, in the hope that it would incentivize manufacturers to voluntarily lower prices — thereby limiting patient access to treatment, while at the same time contributing to addressing the underlying causes of high housing prices. reason.
Likewise, the latest proposal to pass Congress as part of the broader Build Back Better Act also risks the unintended consequences of putting providers and their patients in the middle of proposed negotiations between Medicare and drug manufacturers. In December, ACR joined two other professional societies suggest solution This will exempt Part B compensation from seizure. We support this proposal as a solution that protects our patients from getting Part B treatment while reducing the cost per person.
As the professional organization of rheumatology providers, ACR has a responsibility not only to care for the medical needs of our patients, but also to advocate for ensuring that their treatment is accessible and affordable. Our country has highly innovative drug interventions to help patients – it shouldn’t be costly for anyone to get the treatment they deserve and desperately need. Now is the time for Congress to heed President Biden’s call to action and pass meaningful drug pricing reforms to address the artificially inflated drug costs of manufacturers, PBMs, and payer prescribing relationships.
Photo: cagkansayin, Getty Images
