Congress and policy makers in Washington are intently
focused on how to optimally manage the cost of prescription medications.
Many proposals have already been released, and it’s likely that this focus will
continue well into the 2020 elections and beyond. This is perfectly
appropriate, given that access to medications is a cornerstone of the
management of most medical conditions. It’s also likely that over the
next several months and years, there will be myriad legislative and regulatory
proposals floated, debated, voted on, and in some cases, enacted.
Given the profound impact these policy changes will have on
the efficacy of health care in the United States and, most importantly, the
well-being of patients across the country, Men’s Health Network strongly urges
public-sector policymakers and regulators as well as private-sector payers,
benefit managers, and PBM executives to adhere to the following principles,
which we believe strike a critical balance between the needs of patients, the
importance of innovation, and ensuring a consistent supply chain for medical
products and therapies.
Five Key Principles to Sound Prescription Medication Pricing Reform:
Straightforward and Effective Reforms
Instead of overhauling systems or creating
more complexity and confusion in an already complicated health system, policymakers
should create systems and procedures that are simple, transparent, understandable and effective. This is of
paramount importance to restoring the faith of patients in the system that has
been lost as the processes have become mysterious, veiled in secrecy and overly
complex and convoluted.
- Ensure Cost Reductions Are Passed to
reforms must honor the tenant that was at the forefront of establishing the current
system by returning the lion’s share of cost savings – whether they be
from contract-rates, rebates, price concessions or whatever – to the
patient. Further, the goal of reform should
be to reduce patient out-of-pocket
expenditures for prescription medications from current levels, rather than just
holding the line on costs which are already problematic for many. Returning cost savings to insurance
companies and PBMs (most of which are interlaced) or any other entity other
than the patient is wrong.
Pricing reforms and caps on out-of-pocket
expenditures for medications make sense only if they do not impede access to
treatments. A “rob Peter to pay Paul”
strategy where short term caps are imposed at the expense of significantly
higher premiums or more restrictive access has not worked. If caps are instituted, they should be
designed in a way to reduce out-of-pocket expenses without compromising other
core elements of prescription care or access.
the Provider/Patient Relationship
to the full spectrum of medications and innovative therapies should not be
restricted by limited formularies or an undue trial-and-error
process. The selection of therapeutic
alternatives must honor the wishes and values of patients within a system that
keeps the patient-healthcare provider relationship as the focal point of
treatment decision making.
Markets (Not Government) to Reduce Prices
models and mechanisms should be market based, not dictated by government or
policies. Establishing arbitrary price targets using
reference standards that are not applicable to the needs, wishes and way of
life of American patients undercuts fundamental principles of free markets.
These five principles have one commonality – keeping the long-term
best interests of patients in focus. In
the end that will fulfill the ethical and social obligations of providers,
government and health benefit managers and enhance the care of patients.
As part of our work educating and providing advocacy opportunities
for men, boys and their families, Men’s Health Network will continue to explore
these principles in more depth in the coming weeks. Please check back here on
our blog to follow the series or reach out on social media to engage, ask
questions, and learn more about the policies that impact men’s health.