Health panel: How to improve prescription drug prices, accessibility

Image of giant drug bottle, with large pills spilling out and tiny figures running toward the pills.

By Susan Rupe

WASHINGTON - When it comes to prescription drug prices, panelists at a recent health care conference agreed on two issues.

Drugs don’t work if people can’t afford them.
There is a lack of transparency on what patients actually pay for prescription drugs.

The discussion was part of America’s Health Insurance Plans’ 2023 Medicare, Medicaid, Duals and Commercial Markets Forum.

“Value to patients is what we agree on. That benefit is critical and must be taken into account when we talk about price,” said Merith Basey, executive director of Patients For Affordable Drugs.

Basey took aim at cell therapies and gene therapies as contributing to high prescription drug prices.

'Amazing' gene therapies boost prescription drug prices

“We have these amazing cell and gene therapies – there are something like 400 of them in the pipeline right now and they look promising. But right now, the launch price is in the hundreds of thousands of dollars. This is a big challenge for all of us and must be addressed as soon as possible because the current system will not allow this to move forward.”

Specialty drugs are used by 2% of the U.S. population, but account for 50% of drug costs, said Juan “JC” Scott, president and CEO of the Pharmaceutical Care Management Association. He noted the high cost of biological therapies as opposed to biosimilars. He proposed three areas of focus to encourage biosimilar use.

Regulatory barrier. Scott noted the U.S. is the only nation that has additional approval requirements for biosimilars. “We must make people comfortable with the idea that biosimilars are safe,” he said.
Competition. “The first series of biosimilars we saw coming out this year should have been here years ago,” he said. “We didn’t have enough coming into market to create competition.”
The patent system must be used fairly.

“The fundamental question is why does it make sense to keep coming up with newer ways to pay for expensive drugs? We must focus on initial price setting. There’s a lack of sufficient competition for therapies,” Scott said. “We can’t continue to figure out ways to spread out cost of expensive drugs. We must drive the costs down.”

Scott also called for more transparency on prescription drug prices for consumers. “Patients must understand what they will pay for that drug at the pharmacy counter,” he said.

Michael Sherman, executive vice president and chief medical officer for Point32Health, said access to affordable and effective prescription drugs addresses and improves health equity. He named several issues that would improve that access.

We must identify those patients for whom access and affordability is a problem and deal with them on an individual basis.
We need better data. Sherman said the problem with clinical trials is that they are mainly done with white males and the data obtained in those trials doesn’t always reflect a diverse population.
In cases where the data was developed using unilateral populations, pharmaceutical companies don’t know what other genetic and lifestyle issues play into a particular health condition because they haven’t studied diverse populations.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.