By PERCIVAL BARRETTO-KO
APRIL 18, 2019
A new drug that cures, or at
least delays, a deadly disease like cancer represents a huge advance — unless
no one can afford it. Innovation without access is meaningless.
In the
past five years, we have witnessed the emergence of revolutionary scientific
innovations for treating cancer such as immunotherapies, targeted oral cancer
medicines, gene therapies, and more. These new approaches are turning many
daunting cancers into manageable conditions.
These new
advances won’t realize their full potential, however, unless patients have
access to them. As long as patients struggle to pay out-of-pocket costs or are
unable to access medicines that may save their lives, the promise of these new
therapies goes unfulfilled. This is particularly true for older Americans, who
are more likely to develop cancer than younger individuals and who may be
living on fixed incomes.
Since
its inception in 2006,
Medicare Part D has filled a longstanding gap for this population, serving as
an effective market-based solution that provides seniors with affordable access
to the vast majority of the medicines they need to stay healthy.
Part D
has remained relatively unchanged over the last 13 years while revolutionary
advances have occurred in the development of complex cancer therapies. As a
result, there are now legitimate concerns that Part D, while still an
invaluable asset for most health conditions, is falling short in providing
protection for seniors who rely on specialty treatments to battle cancer and
other deadly diseases.
Current
Part D benefit designs result in high out-of-pocket costs for
many seniors. Over 40% of cancer treatments covered by Part D require more than
$250 in out-of-pocket payments for each prescription. That’s a problem because high
cost sharing has been linked to reduced adherence to medicines, risking
the health of this vulnerable population. In addition, Part D is front loaded,
forcing seniors to bear most of the costs at the beginning of the “donut hole,” which
seniors must get through before catastrophic coverage kicks
in.
When it
comes to affordability, all stakeholders have roles to play. Biopharmaceutical
companies like the one I lead must work creatively and collaboratively with
insurers, pharmacy benefit managers, federal and state governments, and others
to provide access to prescribed therapies. We also have a responsibility to
ensure that our medicines are priced fairly in a way that reflects the
innovation and value they deliver to patients, health care systems, and
society.
I see
four ways to help Medicare Part D evolve with the rapid pace of medical
innovation so the focus remains on access. These practical approaches, which
directly address benefit design, can be implemented without fundamentally
changing the program’s successful competitive structure.
First,
when drug companies negotiate discounts and rebates with insurers and pharmacy
benefit managers, those savings should be passed directly to Part D
beneficiaries. It’s the right thing to do, and will only serve to benefit
patients. The Department of Health and Human Services recently proposed a rule in
this vein that would be a step in the right direction. This alone, however,
will not bring enough relief to seniors.
Second,
patients should be given the option of spacing their out-of-pocket costs for
specialty medicines over time, instead of burdening them with unreasonably high
payments upfront. This would allow seniors to better plan for the cost of their
treatments. If utility companies can do this with heating and air conditioning
bills, Medicare can do it for medications.
Third, if
a physician deems that a particular therapy is most effective for treating an
individual’s illness, she or he should be able to request lower cost sharing
for the drug even if it isn’t on the insurance plan’s preferred “tier.”
Insurers should acknowledge that patients do not respond identically to
specific medicines, and long-term savings can be achieved by getting the
treatment right the first time.
Fourth,
just as Medicare Advantage caps annual out-of-pocket spending for hospital
care, laboratory tests, and other services, Part D should do the same thing for
spending on medications. It is unjust to saddle seniors with unlimited,
uncapped spending merely because they are able to manage their medical
condition at home with prescription therapies, rather than through costly
medical procedures and hospital care.
An
estimated 1.7 million Americans,
many of them over age 65, will be diagnosed with cancer this year. Medicare
Part D has been an unequivocal success for millions of aging Americans, but it
is now falling short in protecting those facing some of the most deadly
cancers. As new discoveries are made that can extend the lives of people with cancer,
modernizing Medicare Part D isn’t just a matter of public policy. It’s a
pathway to hope and the prospect of living life to the fullest.
Percival
Barretto-Ko is the president of Astellas
Pharma US.
https://www.statnews.com/2019/04/18/medicare-part-d-evolve-fight-cancer/
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