Health Care Affordability Goes Beyond Just Drug Prices: H. John Beardsley and Fauzea Hussain

Beyond drug costs, there are systemic barriers that continue to impact the affordability of drugs, including the fragmentation of benefits, said H. John Beardsley, MBA, senior vice president of corporate strategy and business development at CoverMyMeds, and Fauzea Hussain, MPH, vice president of public policy at McKesson. Addressing this issue also requires policy makers look at the totality of the drugs a patient might be on instead of just the affordability of 1 drug.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Beyond drug costs, what systemic barriers still limit affordability, and how should policy makers address them?

Beardsley: Fragmentation in the benefit is not a new concept. We talk about it in our Medication Access Report a fair amount. One of the biggest things is just affordability in general. There are multiple ways for patients to find ways to afford the therapy that their doctor thinks is right for them. Some of that is within the benefit, and I think the IRA [Inflation Reduction Act] does help by providing a $2000 annual cap. But it also still has a rather high deductible that the patient needs to meet before they start to take advantage of that $2000 max out-of-pocket cap.

As a result, they may look at multiple different solutions for affordability—could be pharma-sponsored programs, could be discount cards, could be other ways outside of benefits that would help them with their affordability issues. That's still a big area for us to sort out as an industry, and possibly an area for policy and the IRA in general to start to recognize is, there is still what you would call financial toxicity even in the benefit today.

Hussain: We're driving towards, we need more transparency, and education to empower patients to help make the best choices for themselves, whether it's on their benefit or outside of their benefit. Then the other place that I would say is that we usually talk about affordability with just the drugs and the treatments, but we don't really focus in on the services and diagnostics that are needed for patients before they can even get a prescription for a medication that's critically necessary.

I do think that policy makers need to take a step back and look at affordability across the patient journey. I think that's really critical in terms of, how do we start to address barriers to access and affordability?

I also think we need to look at affordability more broadly. Usually, it's in the context of one drug, right? Can you afford this one product? But it's never in terms of the totality of your overall, what I will call, your medicine cabinet. One product may be affordable, [the] second product may not be affordable, [and then] when you hit your tenth [therapy] if you're on chronic meds. I think we need to look at affordability maybe more as like what's in your medicine cabinet.

Beardsley: That's especially important for seniors who are far more likely to have multiple therapies that they're on, far more likely to have 5 or more drugs in their medicine cabinet, so to speak, and also far more likely to be on fixed income and therefore need different kinds of support to even afford the 5 or more drugs that they might be on.