Building A Better Health Care System
As health insurance companies increasingly shift health care costs onto patients through high deductibles and coinsurance, more than one third of insured Americans report spending more in out-of-pocket costs than they could afford in the last month. That’s not how insurance is supposed to work.
Many patients may not know it, but there are tens of billions of dollars in rebates and discounts on medicines that are given to insurance companies and other middlemen. Too often these rebates and discounts don’t get to patients who need them. As a result, some patients pay more for medicines than their insurance company pays.
Unlike current price setting proposals in Congress that threaten Americans’ access to crucial, breakthrough medicines, we should make sure the rebates and discounts insurers receive get passed on to patients at the pharmacy counter – not pocketed by the insurance companies, hospitals and middlemen. And we should cap out-of-pocket costs for seniors and people with disabilities on Medicare and make those costs more predictable throughout the year.
Let’s work together to make sure medicines are more affordable and accessible for patients in need.
Making Medicines More Affordable
Every reform must pass a simple test: does it benefit the patient and protect future innovation? Temporary fixes based on political rhetoric are destabilizing and counterproductive – only sustainable, patient-centered solutions will help those who need it the most. We propose policies to make medicines more affordable by:
Making Insurance Work
Making insurance work like insurance by covering more medicines from day one, making out-of-pocket costs more predictable, ensuring cost-sharing assistance applies to deductibles and sharing negotiated savings with patients at the pharmacy counter.
Modernizing how Medicare covers and pays for medicines, including capping out-of-pocket costs in Part D, lowering cost sharing and spreading those costs over the calendar year, and making sure the savings negotiated with health plans are passed to patients. It also includes implementing a market-based adjustment in Part B that would allow the government and seniors to benefit from more of the savings already negotiated in the commercial market, which could save some seniors hundreds – if not thousands – of dollars each year.
Protecting the Safety Net
Protecting the safety net by maintaining coverage of medicines for vulnerable patients served by Medicaid and driving greater oversight and transparency of the 340B program to ensure that hospitals and other entities are using the discounts manufacturers provide to serve needy patients, not siphoning resources away from patients.
Ending perverse incentives by tying the fees pharmaceutical supply chain middlemen charge to the services they provide, not the list price of a medicine, and fostering the competitive market for medicines while also providing needed incentives for continued biopharmaceutical innovation.
Tell Congress to Hold Middlemen Like Insurers and PBMs AccountableTake Action
HOLD MIDDLEMEN ACCOUNTABLE
Tell Congress to Hold Middlemen Like Insurers and PBMs Accountable
Too many Americans struggle to afford the medicines and health care they need. And the problem has gotten worse in recent years as insurers increasingly use practices that shift costs to patients. If Congress is serious about making medicines more affordable, then it needs to take a holistic approach. Congress could meaningfully address patient access and affordability concerns if they pursued legislation that included more accountability and transparency of Pharmacy Benefit Managers (PBMs), addressed a broken insurance system that is shifting more of the costs of medicines onto vulnerable patients, and took steps to ensure patients share in the deep discounts that PBMs and health plans receive. Tell Congress that it must reject price setting proposals and work on real solutions to make sure patients can afford their medicines at the pharmacy counter. Tell Congress there is a better way.
Fulfilling the Commitment
Fulfilling the biopharmaceutical industry’s commitment to help end the pandemic by expanding collaboration and manufacturing capacity and ensuring affordability and access to COVID-19 vaccines andtherapeutics.
Enhancing Supply Chain
Enhancing globally diverse biopharmaceutical manufacturing supply chains by fostering collaboration and advancing our R&D and manufacturing infrastructure.
Investing in Preparedness
Investing in pandemic preparedness and planning by creating a robust, long-term national preparedness strategy, such as modernized data and reporting infrastructure and a fully developed vision for the Strategic National Stockpile.
Thwarting Rising Threats
Ensuring a sustainable pipeline for new treatments to take on an emerging threat that’s right before our eyes – rising antimicrobial resistance.
Building a More Just, Equitable Health Care System
COVID-19 and the disproportionate impact it has had on communities of color has shown us that the time to fix inequities in our health care system is right now. Communities of color must finally receive the highest quality of care. Every patient deserves the opportunity to make rational and informed decisions about their own care. We commit to industry action and to supporting policies that will build a more just, equitable health care system, including:
Improving Clinical Trial Diversity
Improving clinical trial diversity and building an industry workforce as diverse as the communities we serve by encouraging a culture of inclusion and investments in educational pathways.
Investing in Data
Investing in rigorous data and measurement infrastructure by improving data collection and reporting that more accurately measures health disparities.
Promoting Best Practices
Promoting best practices for improving equity in health care screenings, diagnosis and treatment.
Aligning with Equity Goals
Align incentives with equity goals by supporting equity-focused quality metrics and equitable access to medicines for all communities.
We are working to deliver a more affordable and equitable health care system for all. For a summary and detailed overview of PhRMA's patient-centered agenda, click below.