not used title

not used title

As the public focus on new, innovative diabetes and anti-obesity medicines has increased, so have attempts by insurers and others to distort the facts about the potential costs to the health care system.

We shouldn’t be surprised.

Every time new groundbreaking medicines are approved insurance companies claim these life-changing innovations will bankrupt the health care system.

Here’s what it looks like: overestimate the potential costs of providing access to new transformational medicines, ignore that payers leverage competition to extract significant discounts that lower the costs of brand medicines, undervalue the savings from treatment and prevention, and overlook that medicines are the only part of the health care system where prices go down over time.

Insurers use these scare tactics as an excuse to put in place unnecessary and burdensome restrictions or to deny coverage altogether. Their answer to health care is to simply not pay for it.

Yet, as we’ve seen with life-changing treatments and cures for high cholesterol, Hepatitis C, and others, claims about the financial havoc to come have turned out to be false. In fact, we saw just the opposite because we have a competitive market that results in significant rebates and discounts, and eventually low-cost generics and biosimilars. 

What was said about innovative cholesterol-lowering medicines, called PCSK9 inhibitors:

• CLAIM: ICER predicted the one-year budget impact of these medicines to reach $7.2B. 
• REALITY: Data shows annual spending on these medicines was just 2.7% of ICER’s prediction.
  
  
• CLAIM: Express Scripts argued in 2015, “It is clear that PCSK9 inhibitors are on a path to become the costliest therapy class this country has ever seen.”
• REALITY: A few months later, Express Scripts stated, “We feel very confident we can manage this, and this won’t mess up our clients’ budgets in 2016.”
  
  
• CLAIM: A 2015 study in the New England Journal of Medicine argued that annual premiums for every American would increase by $124 from the uptake of PCSK9 inhibitors alone.
• REALITY: 2016 Avalere data showed increases for monthly premiums attributed to ALL prescription drugs was only $3.29.

What was said about groundbreaking new Hepatitis C cures:

• CLAIM: PricewaterhouseCoopers predicted sales for one Hepatitis C treatment would hit $2.9 billion in year one.
• REALITY: The actual first-year sales were only 28% of that prediction.
  
  
• CLAIM: Express Scripts predicted in July of 2014, “…this particular drug will break the country… It will make pharmacy benefits no longer sustainable. Companies just aren’t going to be able to handle paying for this drug.”
• REALITY: Express Scripts said six months later: “The price is sufficiently low that we can go to our clients and say that they can treat every patient with hepatitis C.” The company went on to say later, “Our clients will save more than $1 billion this year on hepatitis C medications…”
  
  
• CLAIM: In 2014, AHIP claimed, these treatments would have, “…a tsunami effect across our entire health care system.”
• REALITY: In 2015, the NYT Editorial board wrote, “Competitive market forces and hard-nosed bargaining” make ‘tremendously effective’ new hepatitis C medicines not just more accessible to ailing patients — but also offer good value to the U.S. health care system.”

These are just a few examples, but looking back, we consistently see this story repeat. A study from the Partnership for Health Analytics (PHAR) looking at 25 predictions of the cost of new medicines over a five-year window showed almost half of those predictions were off by more than $1 billion.

This rhetoric isn’t just misleading; it leads to real access barriers and restrictions for patients who rely on medicines.

In the case of anti-obesity medicines, data shows discounts and rebates already lower the net costs of treatments by as much as 79%. A recent analysis that looks at net spending shows spending is far less than recent reports that overlook these substantial negotiations.

We shouldn't give insurance companies another free pass to find more reasons to discriminate against people who need medicines. Instead, our focus should be on incentivizing the development of and expanding access to new innovative medicines that treat and prevent diseases.

Alex Schriver

Alex Schriver currently serves as Senior Vice President of Public Affairs at the Pharmaceutical Research and Manufacturers of America (PhRMA). Schriver leads the communications team responsible for earned, paid, digital and social media, as well as executive visibility. Schriver has extensive experience in communications, campaigns, and crisis management. He has advised global corporations, government leaders, and corporate executives throughout his career.

Alex Schriver

Insurers routinely block seniors’ access to medicines in Medicare Part D

March 18, 2026

New study: PBMs and commercial insurers are quietly blocking prescription access

July 30, 2025

CMS, don’t fall behind the rest of the medical community on obesity

February 14, 2025

New PES survey: Out-of-pocket costs lead key health care priorities ahead of the November election

October 30, 2024

Guest Post: My health care vote

October 29, 2024

Americans speak out on health insurance barriers and need for policy change, according to the latest Patient Experience Survey

October 28, 2024

New Report: Tackling chronic conditions with preventive treatment

September 30, 2024

PBMs and insurers off the hook: Sen. Sanders’ selective hearing on drug costs

September 24, 2024

Key voter insights two months from Election Day

September 10, 2024

Patient priorities in the 2024 election

September 10, 2024

More oversight needed of unapproved medicines that threaten patients’ health

August 1, 2024

Voters across all 50 states want state policymakers to focus on health insurance and PBM practices

July 30, 2024

New 50-state poll Americans want to hold health insurers and PBMs accountable for high out-of-pocket costs and other practices

July 9, 2024

ICYMI: What patients care about this election year

June 24, 2024

ICYMI: Misaligned policies undermine patient access

June 6, 2024

PhRMA Warns Federal Agencies: Consolidation and vertical integration among insurers, PBMs, and hospitals threaten patients

June 5, 2024

Ongoing federal probes shed light on PBM and insurer practices

May 20, 2024

WTAS: The consequences of consolidation and vertical integration

May 6, 2024

IRA is already negatively impacting access to medicines in Part D

April 25, 2024

Insurance data: PBM reform has no material impact on premiums

April 24, 2024

New study finds insurers and PBMs increasing access restrictions in Medicare Part D

April 16, 2024

What recent rhetoric on the cost of diabetes and anti-obesity medicines gets wrong

April 9, 2024

3 Takeaways from POLITICO’s Health Care Summit

April 3, 2024

Setting the Record Straight: Comparing U.S. drug prices to those in foreign countries hurts patients

February 7, 2024

When it comes to the future of innovation, the ball is in policymakers’ court

January 22, 2024

Taking stock of obesity and its costly effects

December 8, 2023

ICYMI: When middlemen get in the way, it’s the patients who lose

December 5, 2023

Increased use of prior authorization in Medicaid is blocking access for patients

November 28, 2023

ICYMI: WSJ — Same Drug, Two Prices: Why the Higher Price Prevails

November 15, 2023

One year to Election Day: Four voter priorities to watch

November 6, 2023

New PhRMA ad exposes yet another way PBMs get between patients and their medicines

September 5, 2023

AARP’s latest misleading report

August 11, 2023

New report: Hospitals mark up medicine prices 500%

August 2, 2023

read more

August 2, 2023

Navigating the Patient Experience Survey: Protecting Lifelines to Access and Innovation

July 26, 2023

Three things to know from the latest Patient Experience Survey

July 20, 2023

Key considerations as Congress works towards PAHPA reauthorization

July 12, 2023

ICYMI: PBM exec admits choosing profits over patients

June 2, 2023

Insulin: Key Facts on Access & Affordability

May 10, 2023

4 key facts on medicine prices and spending

May 9, 2023

4 Things to know about PhRMA’s new 50-state poll

May 4, 2023

Three facts about health care spending

April 25, 2023

AHIP’s latest misinformation campaign & what it’s trying to hide

April 24, 2023

ICYMI: PhRMA President and CEO Stephen J. Ubl discusses patient affordability

April 7, 2023

States can support access to medicine as COVID-19 Public Health Emergency ends

April 5, 2023

Arkansas puts patients first with new share the savings law

April 4, 2023

Key Trends: Patient experience data reveal how insurers and middlemen impose barriers in health care

March 29, 2023

Insurer and PBM tactics are shifting higher costs to patients with chronic and complex conditions

March 2, 2023

Holding pharmacy benefit managers accountable

February 23, 2023

Stopping pharmacy benefit managers from “gaming the system”

February 22, 2023

Senate hearing to examine bipartisan reforms to rein in middlemen

February 16, 2023

Minnesota lawmakers are letting PBMs off the hook, and threatening patients’ access to medicines

January 31, 2023

ICYMI: Cancer death rate continues to decline due to treatment advances

January 25, 2023

Novel medicines approved in 2022 offer increased treatment options for patients

January 23, 2023

ICYMI: PhRMA kicks off the year at the 2023 J.P. Morgan Health Care Conference

January 19, 2023

Study finds hepatitis C cure saved Medicaid $15 billion

January 5, 2023

ICYMI: PhRMA COO Lori Reilly speaks about the health care agenda for the next Congress

December 9, 2022

In their own words: Financial barriers exacerbate access challenges for insured Americans

December 8, 2022

Medicare Part D open enrollment and what recent changes mean for beneficiaries

November 17, 2022

New data show how insurers and middlemen shift Rx costs onto patients

November 16, 2022

In their own words: Insured Americans struggle to navigate complex coverage

October 26, 2022

Many seniors are paying more for Part D medicines than their insurer

October 18, 2022

New comments outline ways to protect patients from health plans and PBMs who profit from patient assistance

October 7, 2022

Busting 3 Myths About Copay Coupons

October 5, 2022

Mental Illness Awareness Week – A time for reflection

October 3, 2022

Navigating the patient experience: Burdens and barriers standing between patients and their care

September 12, 2022

Making coupons count for patients at the pharmacy counter

August 25, 2022

Insulin and reconciliation

August 15, 2022

Making coupons count for patients with HIV

August 8, 2022

By the Numbers: Patients lose when the government sets prices

July 8, 2022

Patients win as West Virginia implements first-in-nation share the savings policy

July 8, 2022

3 things voters are concerned about when it comes to their health care coverage

July 7, 2022

Prescription drug prices are not fueling inflation

July 6, 2022

Copay assistance is a lifeline for patients. So why are insurers blocking it?

June 29, 2022

New poll shows voters sounding the alarm on health insurance companies and PBMs

June 6, 2022

PhRMA warns of the growing influence of middlemen over patient access and out-of-pocket costs for patients

May 31, 2022

Report finds PBMs are increasingly restricting patient access to medicines

May 25, 2022

ICYMI: PhRMA CEO Stephen J. Ubl spotlights lessons learned during COVID-19

May 13, 2022

ICYMI: PhRMA COO Lori Reilly spotlights efforts to improve health care in 2022 and beyond

May 9, 2022

Annual projections from NHE compared to actual health care spending

May 5, 2022

Study finds insurance barriers disproportionately burden patients with chronic illness

May 4, 2022

What’s really happening when it comes to prescription drug costs

April 27, 2022

5 public opinion polling trends to watch

April 22, 2022

Analysis: States can help patients save nearly $1,000 annually on their medicines

April 21, 2022

New analysis confirms hospitals markup prices for oncology therapies

April 21, 2022

How standardized plans can improve patients’ access to medicines

April 18, 2022

The patient experience: Uncovering the barriers to care for insured Americans

March 28, 2022

Correcting the record: Putting medicine costs and spending in context

March 24, 2022

Sharing rebates can save Americans with diabetes 500 each year and improve adherence

March 16, 2022

Guest Post: If we truly want to cure complex diseases, politicians should reject price setting

March 14, 2022

Veterans Affairs 101: Three charts show how the VA system differs from Medicare

March 11, 2022

If drug prices are growing below the rate of inflation, why are patients still feeling the sting at the pharmacy?

March 8, 2022

The patient experience: Insurance barriers continue to impede access to health care, especially among the country’s underserved

February 28, 2022

Government price setting leaves behind families counting on new medicines

February 23, 2022

PhRMA submits comments urging CMS to withdraw coverage proposal

February 11, 2022

340B 101: Three charts show the program maximizes hospitals’ bottom line with little consideration for patients

February 8, 2022

Research and development continues long after a medicine is initially approved

February 1, 2022

New comments outline ways to counteract cost-shifting insurance trends

January 28, 2022

Patients need to pay less for their medicines. States can help.

January 26, 2022

New poll of all 50 states and 435 Congressional Districts shows perils of so-called Medicare “negotiation”

January 25, 2022

CBO reaffirms our innovation ecosystem leads to improved lives, long-term savings

January 21, 2022

New study finds more than half of brand medicine spending goes to the supply chain and others

January 7, 2022

New NHE data show the true picture of health care spending

December 22, 2021

3 things to know about the importance of post-approval research and development

December 6, 2021

Guest post: Congress should not put future innovation at risk

November 29, 2021

What is missing in the current drug pricing plan

November 23, 2021

ICYMI: PhRMA CEO speaks at STAT Summit about government price setting

November 19, 2021

In the current health care debate, Congress has lost sight of what matters to U.S. voters

November 15, 2021

The patient experience: Insurance design hurdles lead to access issues for too many Americans

October 28, 2021

CMS finds medication adherence saved Medicare up to 46.6B in avoided health care costs between 2013 and 2018

October 19, 2021

ICYMI: New study confirms policies like H.R. 3 could significantly reduce drug development

October 18, 2021

New poll shows Americans reject Medicare negotiation once they learn more about the policy

October 15, 2021

To drive up profits, hospitals continue unnecessary medicine mark-ups, burdening patients, employers and health care system

October 14, 2021

What is Kaiser Family Foundation up to?

October 12, 2021

Recognizing Hepatitis R&D on World Hepatitis Day

July 28, 2021

New reports shed light on key facts about medicines and affordability

June 8, 2021

How strengthening the biosimilar marketplace benefits patients

May 18, 2021

New report demonstrates development of new medicines relies on private sector expertise and investment

May 10, 2021

West Virginia becomes the first state to lower patient costs by sharing the savings

April 20, 2021

Top five issues voters want addressed in the administration’s first 100 days

February 18, 2021

Insurers shift medicine costs to patients with severe chronic illnesses

February 1, 2021

Election insights: Voter priorities in the states

December 17, 2020

Accumulator adjustment programs lead to surprise out-of-pocket costs and nonadherence, analysis finds

November 19, 2020

Survey found insurance premiums grew faster than inflation in 2020

October 20, 2020

Manufacturer cost-sharing assistance programs can save chronically ill patients hundreds to thousands of dollars annually

August 19, 2020

Commercial health plans have increased patients’ out-of-pocket costs by over 50% in some therapeutic areas

August 12, 2020

Commercial health plans transition from copays to coinsurance and deductibles has increased patient out-of-pocket costs

August 6, 2020

Four things to know about the IQVIA “Medicine Spending and Affordability in the U.S.” report

August 5, 2020

New data show commercially insured patients face increasingly high cost sharing for brand medicines

July 30, 2020

Payers subject 80% of new RA and MS patients to utilization management restrictions

July 22, 2020

ICYMI: Pharmacy benefit managers increasingly exclude medicines from formularies, restricting patient access

June 1, 2020

New rule makes it harder for patients to lower their out-of-pocket costs

May 20, 2020

PhRMA comments on HHS proposed rule on manufacturer cost-sharing assistance and accumulator adjustment programs

March 3, 2020

Fact Check: HCCI analysis overstates medicine spending and prices

February 19, 2020

Cancer medicines cost twice as much at hospitals, study finds

January 21, 2020

Nearly 50% of brand medicine spending goes to the supply chain and others

January 9, 2020

More evidence that medicine prices are growing at slowest rate in decades

October 4, 2019

Survey shows out-of-pocket costs top health care concern for voters

October 2, 2019

Four reasons why the radical Pelosi Plan is the wrong approach

September 24, 2019

Hospitals make 9 times more than physicians’ offices on provider-administered medicines

September 10, 2019

Three things to know about the Part D GAO report

August 16, 2019

Setting the record straight on international reference pricing

July 16, 2019

New Let’s Talk About Cost TV ad asks: Why aren’t patients sharing in savings at the pharmacy counter?

July 9, 2019

Study finds hospitals continue to mark up medicines up to 500% of their cost

July 9, 2019

Three reasons why the latest Rx Savings Solutions analysis is misleading

July 2, 2019

"If Washington isn’t careful, we might leave innovation behind"

June 24, 2019

Ask About Adherence: OIG proposed rule to reform the rebate system could improve adherence

May 15, 2019

New study finds hospitals continue to push patients to costlier outpatient settings

May 13, 2019

4 Things to know about the IQVIA “Medicine Use and Spending” report

May 9, 2019

Meet MAT: 5 things to know about PhRMA’s new “Medicine Assistance Tool”

May 9, 2019

The PBM story you haven’t heard: Hidden fees quadrupled in two years

March 20, 2019

Health Affairs study misses the mark on medicine costs

January 28, 2019

New government data show medicine price growth continues to decline

January 18, 2019

Americans want to know more than just the list price of a medicine—and we’re answering their call

October 15, 2018

What they are saying: PhRMA member executives on industry’s new approach to DTC television advertising

October 15, 2018

Coupons allow patients to remain on medicines in spite of high cost sharing and deductibles

October 4, 2018

Experts agree: the Bipartisan Budget Act changes to Medicare Part D jeopardize the program

September 24, 2018

New whitepaper identifies reasons why ICER’s cost-effectiveness analyses are not useful for payers

September 19, 2018

What if a couple of small fixes could protect seniors in the donut hole and save them money on out-of-pocket costs?

September 13, 2018

New study finds some hospitals mark up medicine prices at least 700 percent

September 5, 2018

69 percent of patients abandon medicines when cost sharing is more than $250

August 23, 2018

New analysis in Health Affairs reinforces one-third of medicine list price rebated back to supply chain

August 13, 2018

PhRMA submission to HHS on blueprint to lower drug prices and reduce out-of-pocket costs

July 16, 2018

New data show patients’ out-of-pocket costs are rising faster than their insurers’ costs

July 9, 2018

Medicare Part D cliff ahead

June 21, 2018

Part D cliff looms for seniors, as program stability could be in jeopardy

June 18, 2018

Sharing negotiated discounts at the pharmacy counter could save seniors with diabetes more than $350 annually

May 17, 2018

New “Let’s Talk About Medicare” campaign focuses on solutions to improve affordability and predictability for seniors in Part D

May 9, 2018

Video: PhRMA CEO discusses biopharmaceutical supply chain at POLITICO event

May 4, 2018

Event tomorrow: Making the biopharmaceutical supply chain work for patients

May 2, 2018

Spending on medicines grew less than one percent in 2017

April 19, 2018

Patients pay the price when hospitals mark up cancer medicines

April 5, 2018

Advance price notification: A transparency measure that fails patients

March 29, 2018

New Let’s Talk About Cost ads highlight how copay accumulator programs could leave patients financially exposed

March 27, 2018

Video: How does the supply chain shape brand-name medicine prices?

March 19, 2018

4 Things to know about the IQVIA 2018 and Beyond: Outlook and Turning Points report

March 13, 2018

ICYMI: Two PBM reports show dramatic slowdown in medicine spending growth

March 2, 2018

Copay coupons can help ease patients’ out-of-pocket costs

February 16, 2018

Oregon’s HB 4005 fails to deliver savings for patients

February 14, 2018

PhRMA launches new consumer-facing Let’s Talk About Cost website

January 24, 2018

NHE Data: Medicine spending grew just 1.3 percent in 2016

December 12, 2017

Video: What is a results-based contract?

November 13, 2017

Excerpts from testimony by PhRMA’s Lori Reilly

October 17, 2017

4 things to know about the QuintilesIMS drivers of medicine spending in the U.S. report

September 28, 2017

What they are saying: Study on cancer R&D costs is not an accurate representation of marketplace

September 12, 2017

ICYMI: New report outlines steps for greater transparency in health care

August 4, 2017

Video: PhRMA CEO discusses medicine costs with CNBC's Squawk Box

July 31, 2017

New PhRMA resources chock full of biopharma industry facts

July 20, 2017

New “Let’s Talk About Cost” campaign convenes national dialogue on medicine costs

July 12, 2017

New data put medicine costs and spending in context

June 26, 2017

In the OECD other health care services will be ten times prescription medicine spending growth over next decade

June 14, 2017

Medicines have significantly increased chances of cancer survival around the globe

May 24, 2017

Why won’t the insurance industry tell the truth about medicine costs?

May 10, 2017

4 Things to know about the QuintilesIMS Medicines Use and Spending in the U.S. report

May 4, 2017

New analysis: More than half of patients’ out-of-pocket spending for brand medicines is based on full list price

March 29, 2017

How innovative medicines are benefiting countries across the globe

March 1, 2017

ICYMI: 3 new reports show dramatic slowdown in medicine spending growth

February 17, 2017