States Can Help Patients Pay Less for Their Medicines
States Can Help Patients Pay Less for Their Medicines
America’s biopharmaceutical companies agree that, for too many Americans, the health care system is not working and needs to change. No one should struggle to afford the medicines they need. Unfortunately, some patients continue to bear more of their medicine costs at the pharmacy counter.
That’s why our companies are advocating for common-sense reforms to make insurance work like insurance and ensure that patients can access and afford the medicines their doctors prescribe.
Unfortunately, some state policy proposals put access to current and future medicines at risk, threaten ongoing research and development into new treatments and cures and jeopardize the high-paying jobs supported by the biopharmaceutical industry.
We believe there is a better way to help patients pay less for their medicines without sacrificing access to medicines, innovation and jobs.
State Policy Solutions
Share the savings
On average, more than half of spending on brand medicines goes to health insurers, PBMs, the government and others, not the manufacturer that researched and developed the medicine. However, patients often do not benefit from these significant discounts in the form of lower out-of-pocket costs for their medicines.
That’s not right, and it needs to change.
If insurance companies and middlemen don’t pay the full price for medicines, patients shouldn’t have to either. These rebates and discounts must be directly shared with patients at the pharmacy counter.
Make Coupons Count
In some cases, health insurance companies are not allowing the coupons manufacturers provide to patients to count towards deductibles or other cost sharing requirements, meaning patients could be paying thousands more at the pharmacy than they should be.
We need to end this practice so that patients are getting the full benefit of programs meant to help them access their medicines.
Offer Lower, More Predictable Cost Sharing Options
Actual spending on medicines is growing at the slowest rate in years. Unfortunately, it doesn’t feel that way for patients. Insurers are increasingly using high deductibles and coinsurance that result in patients paying more for certain medicines out of pocket. Patients should have more choices when it comes to their medicine coverage.
Every state should require health insurers to offer at least some health plan options that exclude medicines from the deductible and offer set copay amounts instead of forcing patients to pay an amount based on the full list price of their medicines.
Cover Medicines from Day One
Insurers increasingly require patients to pay high deductibles before receiving coverage of their medicines. This can lead to patients rationing or not taking their medicines, which can result in devastating consequences to their health.
Policymakers can help patients from day one by requiring all plans to cover certain medications used to treat chronic conditions with no deductible.
Additionally, insurers should be mandated to offer some plans that cover all medicines from day one.
Cap Patient Cost Sharing
Many commercially insured patients are being exposed to high out-of-pocket costs due to increasing use of deductibles and coinsurance. High cost sharing is a barrier to prescription medicine access, especially for patients with chronic, disabling or life-threatening conditions, who shoulder the largest share of the burden.
Cost sharing should not be so burdensome that it prevents patients with insurance from accessing necessary prescription medicines.
Stop PBMs from "Gaming the System"
Health insurance companies use middlemen called pharmacy benefit managers, or PBMs, to negotiate prescription drug prices and develop formularies that determine what medicines people can get and how much they must pay.
Hold PBMs Accountable under State Law
Health insurance companies use middlemen called pharmacy benefit managers, or PBMs, to negotiate prescription drug prices and develop formularies that determine what medicines people can get and how much they must pay. PBMs are supposed to help lower costs for medicines, but they often enrich themselves over the interests of patients and their health plan clients.
State Policy Concerns
Government Price Setting
Government price-setting policies come in a variety of forms, but they all lead to the government inserting itself between patients and doctors, threatening access to treatments and chilling research and development of new medicines. In fact, in other countries that have resorted to government price setting, patients have access to fewer new medicines and wait longer to get the medicines they need. Instead of pursuing proposals that could hurt patients and cripple innovation, we need policies that protect access to treatments and make medicines more affordable.
Prescription drug affordability boards is just one form of government price setting policy we’re seeing pop up in states around the country. These proposals would give bureaucrats the power to arbitrarily set medication prices in a given state. As a result, decisions about medicines would be a part of a political process that changes with elections and the whims of politicians.
Under this policy, the state would evaluate whether certain medicines and treatments are “worth” paying for, meaning the state’s bureaucracy could come between patients and the treatments their doctors prescribe. This spells disaster for patients as they could face barriers to obtaining life-saving medication.
Some states are pushing policies that would wreak havoc on the safety of the U.S. pharmaceutical supply chain. Known as “importation,” these schemes have been proposed in various states as an approach to reducing medicine costs. However, these proposals fail to acknowledge that the resources required to ensure the safety and efficacy of any drugs being imported from or passing through other countries into the United States would outweigh any potential savings. Not to mention playing Russian roulette with patients’ lives by exponentially increasing the risk of counterfeit, adulterated and substandard products entering the United States and harming patients.
The United States is the gold standard when it comes to regulating the safety of our medicine supply. Allowing these importation schemes puts that standard, and patients’ lives, at risk.
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A win for Indiana patients: “Share the savings” legislation now law
Indiana just joined West Virginia and Arkansas in delivering an important win for Hoosiers who are struggling to afford their medicines. This week, Governor Holcomb signed into law Senate Bill 8 recently passed by the Indiana legislature.
MRP Survey Results - 50 State Poll
When asked about policy solutions that their state could pursue to address prescription drug costs, strong majorities of adults favor laws that would require all health insurance plans to cover certain medications used to treat chronic conditions from day one of the plan year (81%) and that would require health insurance companies and their middlemen to pass the rebates and discounts they receive to patients (80%).
State policymakers can protect American innovation and help Americans live longer, healthier lives
To turn that tide, we need new treatments and cures that both extend life and improve it. Fortunately, America’s biopharmaceutical research companies are working to find innovative solutions that can help patients across the United States.
Minnesota lawmakers are letting PBMs off the hook, and threatening patients’ access to medicines
It often doesn’t feel that way for patients because insurers and pharmacy benefit managers (PBMs) have increasingly shifted more out of pocket costs on medicines to many patients through high deductibles and coinsurance. So while health plans routinely base patient cost sharing for services like hospital stays and doctor visits on the negotiated prices the health plans pay, they receive with patients, when it comes to life saving medicines, that’s often not the case.
How the 340B Program Is Contributing to Health Inequities
Over the 30 years since the 340B program was created, it has devolved from one that could have made health care more equitable through improved access to medicines for vulnerable communities to one that has resulted in disparities in how certain populations access care.
Public Opinion Polling
Polling and data insights are critical to informing and understanding how we can develop proactive public policies that address the needs of patients. We are committed to listening to patient voices and drawing key insights from public opinion research to help shape the conversation surrounding these key issues.