Specifically,
patients support policies to stabilize Medicare Part D, which could in turn
reduce out-of-pocket drug costs.
By Sara Heath
July 16, 2018 - Patients
largely support legislative measures that would stabilize the Medicare Part D
program, stating that such measures could reduce rising patient financial
responsibility and out-of-pocket drug costs, according to a Morning
Consult poll conducted on behalf of the
National Community Pharmacists Association (NCPA).
The survey of nearly
2,000 registered voters indicated that certain policies that work to reduce
out-of-pocket drug costs for seniors are especially popular among constituents.
Specifically,
respondents want to see pharmacy benefit managers (PBMs) play a smaller or less
influential role in pharmacy affairs.
Patient respondents
expressed interest in PBMs and healthcare payers passing drug discount savings
onto seniors, with 93 percent of all respondents expressing such. Eighty-four
percent of respondents said they want PBMs to stope charging retroactive fees
for medications. Those retroactive fees often add to the growing out-of-pocket
costs patients incur for their medications.
Ninety-two percent of
respondents said seniors should be allowed to access medications at the
pharmacy of their choosing, which could also reduce patient healthcare costs.
This policy could encourage price shopping by allowing patients to purchase
their medications from the least expensive provider.
Patients will largely
reward Congressional candidates who run on these policies, the survey showed.
Specifically, 75 percent of patients said they would support a candidate who
voted to limit PBMs’ capabilities to charge retroactive pharmacy fees.
Respondents also said
there should be more freedom in the pharmacist-patient relationship. Eighty
percent of respondents said pharmacists should be allowed to tell patients
about less expensive drug options, for example.
These survey results
indicate patient sentiment for public policies regarding pharmaceuticals,
according to B. Douglas Hoey, MBA, NCPA CEO.
"Healthcare
issues ranked high among concerns in this nationwide survey of nearly 2,000
registered voters – and particularly concerns related to the Medicare Part D
prescription drug benefit," said Hoey, who is also a pharmacist.
“Respondents voiced strong concern about the perverse incentive pharmacy
benefit managers have to raise drug prices, including retroactive fees PBMs
charge pharmacies that have the effect of pushing Medicare beneficiaries more
quickly into the coverage gap – the so-called 'donut hole' – and eventually
into the catastrophic phase."
These concerns may be
well-founded, as other evidence has indicated that healthcare and drug costs
are rising for patients. A June 2018 Avalere report showed that Medicare Part D
beneficiaries are paying more for generic prescription drugs, despite the fact
that the market price for those drugs has remained unchanged.
This trend likely
stems from the changing tier on which these drugs are placed in payer
formularies, the analysis explained. Drug formularies are lists of preferred
drugs for different health plans, in some cases determined by clinical
effectiveness and value of the drug. Prescription drug cost and patient
cost-sharing are a part of that value calculation in some cases.
More generic drugs
are being placed on higher formulary tiers, meaning they are placed on tiers
that will eventually cause patients to pay more out-of-pocket for the
medication. Fifty-three percent fewer drugs were placed on the lowest formulary
tier between 2011 and 2015, the report showed.
This shift in
formulary placement ended up costing patients nearly $6.2 billion, a 93 percent
jump in patient cost sharing during that four-year period.
Even patients are not
paying directly out-of-pocket for their medications, they are seeing the costs
elsewhere. A May 2018 analysis from America’s Health
Insurance Plans (AHIP) showed that nearly one-quarter of patient spending on
insurance premiums go toward drug costs. This means that, although not indicate
of out-of-pocket costs, patients are still dedicating a considerable amount of
their healthcare dollars toward prescription drug costs.
To its credit,
federal policymakers reportedly want to cut patient cost-sharing. Earlier this
year, the Trump Administration issued a blueprint for lowering drug
prices for patients. Among other proposals, the blueprint called for better
price transparency and potential amendments to the 340B program and Medicare
Part D.
Since the publication
of that blueprint, CMS has updated its drug price transparency dashboard that
should help patients make informed decisions about their own healthcare
purchasing options. HHS has also recently announced greater oversight of the
340B program to ensure hospitals use discounted prices for their intended use and
pass on cost savings to patients.
However, critics of
the blueprint say it raised more questions than answers and has offered limited
insight into how HHS and CMS will tackle the rising drug cost issue.
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