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Prescription drugs just cost too much.
Especially to seniors on fixed incomes who need their medications to survive. I know because I take meds and I know the cost.
The Campaign for Sustainable Rx Pricing is doing its part to get the costs down — way down.
The Campaign for Sustainable Rx Pricing is a project of the National Coalition on Health Care. The Campaign’s goal is to foster a national dialogue on the pricing of new high cost drug therapies, some of which are now priced at over $1,000 per dose or $100,000 per course of treatment.
According to the Campaign’s website:
• The average American spends $1,200 per year out-of-pocket on prescription drugs.
• Altogether, the 10 largest U.S.-based Big Pharma drug manufacturers pulled in a colossal $245 billion in revenue in just one year.
• As prescription drug prices continue to climb, one in four Americans will not be able to afford their medications.
• Today, prescription drug expenditures are nearly 20 percent of health care costs.
• Prescription spending is growing faster than any other part of the health care dollar.
• According to a recent AARP report, the annual retail cost of widely-used specialty prescription drug therapies in 2013 averaged $53,384 annually. This is more than the median U.S. household income ($52,250) for the same time period, twice as much as the median income for Medicare beneficiaries ($23,500), and almost three and a half times higher than the average Social Security retirement benefit ($15,526).
So what is being done to address this growing problem in America’s health care system?
Pennsylvania’s very aggressive Auditor General Eugene DePasquale recently urged the General Assembly to reduce Medicaid prescription costs by increasing the transparency of how pharmacy benefit managers do business. DePasquale said pharmacy benefit managers, or PBMs, act as middlemen between drug manufacturers and pharmacists.
In a speech to the Pennsylvania Pharmacists Association, DePasquale said many other states have already passed legislation aimed at making PBMs’ practices more transparent so that state leaders can ensure taxpayer dollars are not just lining PBMs’ pockets with no oversight.
“I believe a major part of the reform process is promoting transparency,” DePasquale said.
In December, DePasquale issued a special report — “Bringing Accountability and Transparency to Prescription Drug Pricing” — which noted that Pennsylvania taxpayers paid $2.86 billion to PBMs for Medicaid enrollees in 2017. That marked an increase of 100 percent in just four years — up from $1.41 billion in 2013.
“Dozens of pharmacists have told me that large PBMs, many of which have ties to chain pharmacies, have consistently shortchanged local pharmacies,” DePasquale said. “They’ve done this by reducing reimbursement rates without warning, steering consumers towards more expensive pharmacies, and hiding behind a veil of secrecy.”
In February, he issued a follow-up report focused on manufacturer rebates passed behind the scenes between drug makers, PBMs and insurance providers — never reaching consumers.
Instead of getting a flat fee per prescription, PBMs get a percentage of the total cost of the drug — which can have the unintended consequence of keeping lower-cost drugs from being added to their lists of covered medications, DePasquale said.
DePasquale supported the Pharmacists Association’s push to reform the state Medicaid office’s relationship with PBMs and to eliminate all contract clauses that prevent pharmacists from talking about access to lower-cost drugs. He also called for legislation allowing the state to perform a full-scale annual review or audit of subcontracts with pharmacy benefit managers.
AARP’s Leigh Purvis, director of health services research, recently testified that her organization has identified cost-related issues with high-priced specialty drugs that lack competition and more common brand name drugs with price increases that exceed inflation rates.
“A recent Rx Price Watch Report found that the retail prices of widely used brand name drugs increased by an average of 8.4 percent in 2017 — 4 times the rate of inflation,” she said. “Current prescription drug price trends are simply not sustainable.”
In a statement submitted to the House Committee for the hearing, the American Society of Health System Pharmacists also addressed a need for more competition in drug manufacturing.
It’s time for action.
