We need to improve access to medicines and address patient affordability challenges across the United States.
Last month, I spoke with Matt Salo about this at Informa’s Medicaid Drug Rebate Program Summit. Matt — who is the founder and CEO of Salo Health Strategies and former executive director of the National Association of Medicaid Directors (NAMD) — and I examined the current state of Medicaid and our broader health care system. We also dove into patient access issues at both the state and federal level, including the ways that the government is inserting itself between patients and doctors beyond Medicaid.
During the discussion, I spoke to several solutions to improve access to medicines and reduce out-of-pocket costs.
- Share the savings: In states like Indiana and Arkansas, laws have passed that require insurers and their Pharmacy Benefit Managers (PBMs) to share the discounted price that they get with patients at the pharmacy counter. As more states adopt this model, we’ll see more savings go to patients rather than middlemen. No one should pay more for their medicine than their insurer – that is not how health insurance is supposed to work.
- Make patient assistance programs count: Ensuring the assistance that manufacturers provide to patients count towards deductibles and other cost-sharing requirements is one step forward in increasing access. These programs exist to support people without insurance or when existing commercial coverage fails, increasingly a result of abusive insurance benefit design. Nearly twenty states have already passed policies to guarantee that patients see the full benefit of discount programs intended to help them afford their medicines. Assistance programs would rarely be needed if insurers provided adequate coverage in their formularies.
- Hold PBMs accountable: PBMs continue to game the system for their own benefit at the expense of patients. State policymakers can hold PBMs accountable and address abuses in the system that are making it harder for patients to get the medicines they need.
Click the image below to watch our conversation, and learn more at phrma.org/middlemen.
Scott LaGanga
Scott serves as Executive Vice President of State Advocacy at PhRMA. He oversees state-based teams responsible for government affairs, public policy and advocacy in all 50 states. With a focus on patients, economic growth and the future of medicine, Scott and his colleagues develop and execute campaigns to ensure that states are well positioned to support biopharmaceutical innovation. Scott completed a master’s of business administration at George Washington University in 2009, with concentrations in international business and management. As a Henry J. Raimondo Fellow at the Eagleton Institute of Politics, Scott received a master’s degree in public affairs and politics from the Edward J. Bloustein School of Planning and Public Policy at Rutgers University. He holds a Bachelor of Arts degree in political science from the University of Maryland, College Park.
Scott LaGanga
What AARP isn’t telling seniors about MFN
Policymakers should improve patient access and reject price controls
Insurers blame GLP-1s for rising costs. The data tells a different story.
The FTC’s PBM enforcement actions gave us a glimpse behind the curtain; it’s time to let the light in.
ICYMI: Scott LaGanga and Matt Salo deliver a State of the Industry Report
Out-of-Pocket Costs
PBMs/Insurance
Policy Solutions
State Policy
ICYMI: Scott LaGanga and Matt Salo deliver a State of the Industry Report
ICYMI: Scott LaGanga and Matt Salo deliver a State of the Industry Report