Tyler Gamba

H.R.3, the Elijah E. Cummings Lower Drug Costs Now Act would improve efficiency and produce billions in savings for the commercial health care market’s 

 and end consumers if fully implemented, according to 

 from Milliman commissioned by the West Health Policy Center.

Among its goals, the act’s provisions seek to reduce prescription drug costs, increase drug price transparency, lower member out-of-pocket spending, and increase potential coverage eligibility. Costs for the most expensive brand drugs in the United States would be negotiated between the manufacturers and the HHS secretary. Significant drug cost increases over the rate of inflation would need to be issued back as rebates to CMS.

To predict the effects of such reforms, the Milliman study sought quantitative estimates for the scope of these changes. Milliman’s models incorporated several variables, including current trends and projected spending based on different percentage adjustments to drug prices, rebates, and public vs private cost rates from 2023 through 2029.

The study estimates 46% of drug spending would be subject to negotiation under the legislation’s Title I by 2026, with an average 2.5% reduction in total commercial market claims by 2029.Overall, successful implementation of H.R. 3 means employers may reduce their health care expenditures by $195 billion while employees would save $61 billion. Of this latter amount, reduced premiums would account for $53 billion and out-of-pocket costs, $8 billion.

Overall, the market covered by the Affordable Care Act (ACA) could see savings of $58 billion, comprising $34 billon in reduced beneficiary premiums, $21 billion in federal savings by reduced Advance-Premium Tax Credits, and $2 billion in lower cost-sharing.

The estimates assume manufacturers could make such increases to the prices at a faster rate than the current yearly trends. This possibility still leads to stronger total savings via H.R. 3’s Title I. The study does not factor in further limitations on increases by plan sponsors and pharmacy benefit managers, which could improve savings for employers and employees, because it mainly applies to Medicare.

Under the most conservative pricing model—where manufacturers hypothetically increase supply costs to unprecedented highs to minimize revenue loses—$250 billion in lower costs are still passed on to employers and employees.

Additionally, the study notes that although end consumers are generally responsible for most of their plan premiums, and thus would get most of the savings, the federal government also would save on the significant portion it pays toward member premiums in the individual marketplaces.

To conduct the study, Milliman used data available on enrollees in commercial groups and ACA plans collected on its proprietary Consolidated Health Sources Database (CHSD). Price adjustments were calculated across the 125 most expensive drugs in the Medicare Part D market and all markets.

Milliman emphasized that expected models used in the preparation of the study were applied consistently with their intended use, but will vary in reality. In addition, a limited review of the data used in the CHSD did not find any material defects. The possibility the underlying data collected may be incomplete would only be detected through an audit, which was beyond the scope of the study.

Milliman also did not endorse any specific policy proposals discussed in their analysis. Furthermore, the report note none of the projections in the report can account for the potential impacts that the ongoing COVID-19 pandemic will have on commercial health care expenditures within the years included in the report.

The findings nevertheless give further context that members of the health care field can utilize when planning should H.R. 3 be implemented nationwide.

Cooper J, Hayes M, Alcocer P. Impact of H.R. 3 fair drug price negotiation and inflation rebates on key stakeholders in the commercial health insurance market. West Health Policy Center. Published April 2021. Accessed June 8, 2021. https://www.westhealth.org/wp-content/uploads/2021/05/HR3ANALYSISCOMMERICALMARKET.pdf

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A new study from Milliman investigated the potential financial impact if H.R.3, the Elijah E. Cummings Lower Drug Costs Now Act, was fully implemented.

Adoption of the Lower Drug Costs Now Act May Lead to Billions in Savings

 collected responses on a range of treatment and quality of life (QOL) challenges faced by those with 

—the second most debilitating disease in the world.

The survey was conducted online with nearly 1200 respondents aged 18 to 70. All were diagnosed with migraine at least 2 years ago and reported symptoms including exhaustion and anxiety. Participants had been prescribed or were currently taking a preventive migraine treatment at the time of the survey.

After quantifying results, researchers found a number of commonalities among respondents, with high percentages indicating specific challenges in participants’ daily lives.

A total of 84% of responders wished there were better treatment options than those they were currently taking. Nevertheless, nearly as many responders (82%) reported feeling optimism and hope when starting a new therapy.

Nearly half of women in the survey relayed that menstruation, menopause, or childbirth resulted in hormonal changes that worsened their migraine symptoms.

Additionally, responses from Black and Hispanic participants showed these populations had more doubts and fears about initiating a preventive treatment compared with the rest of the sample. However, over 70% of both groups indicated they wished they had begun treatment sooner.

Results also showed nearly two-thirds of migraineurs reported feeling that life was “passing them by.” General frustration with treatment adjustments, in addition to feelings that attaining optimal control and stability over the disease was out of reach, were also present.

Migraine also resulted in negative impacts on participant productivity, energy levels, mental clarity, personal relationships, and professional growth, constituting significant barriers to individuals’ wellbeing.

“So many people with migraine live in fear every day because they don't know when an attack will hit,” said Jill Dehlin, RN, a migraineur and chair of the National Headache Foundation's Patient Leadership Council.

“In this survey, many people reported feeling they are chasing an unreachable goal to get their migraine disease under control, highlighting the need for new preventive treatment options, as well as resources to educate and empower them to take control of their disease,” she said.

Survey results illustrate the detrimental effects of migraine on daily life. 

Survey Highlights Migraine’s Impact on QOL

Canadian researchers at the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) have published an ethno-epidemiological study 

that supports the use of several strategies for improving adherence to antiretroviral therapy (ART) for people with 

The study authors emphasized 2 recommended actions: (1) for providers to reinforce ART dispensing models that support patient agency and (2) for providers to create ART models that promote situational stability in cases where patients have adverse stressors like housing insecurity and inconsistent daily medication routines.

The goal of the study was to seek context for how key dispensing models affected ART adherence among people living with HIV (PLHIV) who used drugs and lived in low-income housing in Vancouver, Canada.

Participants in the study were required to be 18 years or older, be HIV seropositive, and have used illicit drugs, such as heroin or crystal methamphetamine, in the previous 30 days at baseline.

Thirty-one PLHIV were interviewed a maximum of 2 times at the ACCESS storefront research office. Participants ranged in ages from 29 to 61 years. Fifteen self-identified as women, 14 as men, and 2 as transgender, Two Spirit, or nonbinary. No participants refused to participate or dropped out of the study.

The investigators then imported all interview transcripts into qualitative data analysis software and analyzed them for commonalities in responses. They categorized HIV medication dispensing models into 3 classes—self-administration, daily delivery, and daily pickup—to characterize the impacts of the models.

“Participants reported missing HIV medications due to changes in illicit drug use (eg, frequency, source), regardless of treatment model, and that these changes in their drug use patterns and HIV treatment were shaped by social-structural–level factors (eg, housing vulnerability, lack of agency) that are known to impact ART outcomes,” the researchers wrote.

Being able to integrate ART into an established routine was key to supporting adherence, particularly for those who were responsible for self-administering their treatment each day. The authors noted, “More than other treatment dispensing models, participants emphasized that, under self-administration, adhering to medications was a conscious choice that they had to continue re-making daily.”

Although self-administration offered patients the greatest degree of agency in their HIV treatment, the findings did not indicate a need to incorporate a totally self-administered style of treatment across the board. Rather, the authors wrote that it is beneficial to provide participants a choice in the degree to which a regimented structure for ART dispensing is provided with respect to each participant’s own unique conditions and efforts.

The authors reported there was a notable degree of concordance in the participant interviews and suggested that further data collection with the group would have yielded few new insights.

They also noted that the findings must be considered alongside several limitations of the study. The study sample likely overrepresented PLHIV who are already well connected to health care services relative to the general population of PLHIV who use drugs in cities like Vancouver.

There were additional concerns about the study’s recruitment method excluding those who were unstably housed or not engaged in care or accessing social services.

The authors noted the underrepresentation of transgender, nonbinary, and Two Spirit participants in the study, who are disproportionately impacted by HIV relative to the wider population. The scope of the project also did not emphasize Indigenous participants’ general lived experiences, despite their overrepresentation in those selected for the research.

Nevertheless, the authors believe that their study reinforces a wide body of findings that recommend similar ways to improve ART outcomes.

“Building upon previous research with people who use illicit drugs on asserting agency in health care interactions, our findings underscore how PLHIV who use drugs seek to negotiate agency within, and across, different ART treatment frameworks in a way that that is sensitive to their own treatment needs,” they concluded.

Fleming T, Collins AB, Bardwell G, et al. A qualitative investigation of HIV treatment dispensing models and impacts on adherence among people living with HIV who use drugs. 

. 2021;16(2):e0246999. doi:10.1371/journal.pone.0246999

Adherence to antiretroviral therapy (ART) can be improved by health care providers reinforcing ART dispensing models and creating ART models that promote situational stability, according to a new study.

Tyler Gamba

Articles

Adoption of the Lower Drug Costs Now Act May Lead to Billions in Savings

Survey Highlights Migraine’s Impact on QOL

Study Supports Importance of Patient Agency, Stability in HIV Treatment