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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.
Okon highlighted that in cancer there is a growing disparity between the list price of the drug and the real net price of the drug. He explained that with middlemen, such as pharmacy benefit managers (PBMs), the rebates may get passed along to employers or the health plan, but “I don’t care because they don’t get passed onto the patient,” he said.

Attention to PBMs and rebates has increased recently. HHS has proposed to end drug rebates in Medicare Part D and in Medicaid managed care plans, and the Senate Committee on Finance is following up its hearing on drug prices with 7 executives from pharmaceutical companies with a hearing with the top PBMs.

Okon predicted that a lot of the focus during the hearing will be on what happens to these rebates and to patients who cannot afford their medication.

The cancer space, he added, has a good indication of what is high value and what is not, but the challenge remains about how to finance that value. If there is a $1000 drug and there is a $10,000 drug, the cost to the patient is going to be more for 1 product over the other.

“It doesn’t mean that price is everything…,” Okon said. “It means, it’s affordability, and it means…it’s cost to patient.

Not only is PAN Foundation getting more calls from patients who cannot afford their treatment, but providers are spending more time finding companies who can provide financial assistance, he added.

“Patients are struggling more to pay for their products,” Okon said. “So, the realism of this is that providers have to do more to help the patients. Patients are lost more.”

Klein thinks that in the near future, there will be a cap on Medicare Part D, which would help a large number of beneficiaries. He’s also hopeful that PBM rebates get replaced with a point-of-sale discount that actually lowers the cost for patients in a meaningful way.

Okon is a little more skeptical that anything can be done in the near term, and he especially does not think anything will get done until after 2020 and it will depend on who is in the White House and what control of Congress looks like. But there is one area where he is more hopeful. Employers, he said, are getting fed up with the system and the status quo and he is liking some of the innovation he is seeing from employers.

“I’m hoping they drive [change] and they basically drive the Congress as opposed to Congress driving the other side,” Okon said.

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