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V-BID Summit 2019

The Necessity of Addressing Cost Burden on Patients

Laura Joszt
While the high price of drugs is an issue, what is really important is the actual cost patients are faced with at the pharmacy counter, said Ted Okon, executive director of the Community Oncology Alliance, and Daniel Klein, president and executive director of the Patient Access Network Foundation, at the University of Michigan Center for Value-Based Insurance Design (V-BID), V-BID Summit.
Drug prices may not be sustainable, but what really matters is not the price of the drug, but what the cost is to patients, said Ted Okon, executive director of the Community Oncology Alliance, and Daniel Klein, president and executive director of the Patient Access Network (PAN) Foundation, during a panel at the University of Michigan Center for Value-Based Insurance Design (V-BID), V-BID Summit, held March 13 in Ann Arbor, Michigan.

More and more, patients are paying off the list price, which is much higher than the net price. The new products coming out are more expensive than treatments in the past, but they are better, too.

“We have a lot of good things going on right now,” Okon said. “What’s the bad news? How do we pay for it?”

Klein noted that PAN Foundation is concerned about the new products coming through the pipeline and their cost and what these new treatments mean for the sustainability of PAN, which provides financial assistance to patients who are underinsured.

Access to these novel therapies is really tied to the out-of-pocket (OOP) costs for patients, he explained. Data has shown that $50 is about what patients will pay before they start to become nonadherent, and when more and more people are faced with high-deductible health plans that requires they spend between $2500 and $3000. So, all that cost is hitting at the beginning of the benefit year.

Klein used the hepatitis C drugs as an example. The Institute for Clinical and Economic Review has said that these drugs are a bargain and a great value for most health systems priced at $40,000 a year, but that comes out to a $5000 OOP cost for patients under Medicare Part D. PAN Foundation has found that 4 in 10 patients they help are skipping or cutting doses before they get a grant and for those with incomes under $25,000, half are skipping or cutting doses. In comparison, more than 90% of patients who get a grant from PAN Foundation are adherent to their medications.

This data, according to Klein has shown that OOP costs are more directly important to patients than the over price of a drug.

“Drug prices are clearly important, but from our perspective as a safety net provider, we are faced, day to day, with patients calling us who can’t afford to start their treatment or to stay on their treatment,” Klein said.



 
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