Morning Briefing
Summaries of health policy coverage from major news organizations
Perspectives: Basing Drug Costs On Value Might Make Things Even Worse
As pharmaceutical companies emerge from congressional hearings unscathed, pointing to exciting new medicines and the high cost of research and development (R&D), the question remains: How will society pay for the escalating costs of prescription medicine? While the lifesaving implications of many medications are remarkable, the costs are equally breathtaking. In February, for example, Medicare released a proposal to cover the expensive CAR-T cancer drug. These treatments can run as high as $1.5 million per treatment.To address paying these high costs, drug companies have proposed alternative payment mechanisms, such as health care loans (HCLs) or drug mortgages that would distribute the high upfront cost of a drug over several years. (Robin Feldman, 4/11)
This week, committees in both the Senate and House of Representatives used their power to shine a light on one of the most complex and opaque parts of the prescription drug equation: the practices of pharmaceutical benefit managers. These third-party companies are hired by Medicare, Medicaid, and commercial health plans to create and manage pharmaceutical benefits for more than 266 million Americans. They determine what drugs are covered in their formularies, negotiate prices for these drugs with their manufacturers, set copays for consumers, determine which pharmacies will be included in prescription plans, and decide how much pharmacies will be reimbursed for the drugs they sell. (Elizabeth J. Seeley and Shawn Bishop, 4/11)
Sen. Sheldon Whitehouse (D-R.I.) captured a troubling phenomenon in the world of pharmaceutical drugs during a Senate Finance Committee hearing Tuesday: 鈥淚 stand in awe of the pharmaceutical industry鈥檚 jujitsu magic to have gotten their prime antagonists to become the focus of the problem,鈥 Whitehouse said.Those antagonists are pharmacy benefit managers (PBMs), the much-maligned middlemen in the drug-supply industry, whose executives appeared before the committee to testify on the rising costs of pharmaceutical drugs. (Robert Gebelhoff, 4/10)
