By Troy Zimmerman, Vice President, Government Relations, NKF
Prescription costs are increasingly a concern for patients and insurers, particularly as copayments increase. Additionally, while providing better outcomes for patients, in many instances new innovative therapies incur considerable additional cost for patients and payers. If innovation is unaffordable, it can’t be effective.
Last week, I attended a forum hosted by the U.S. Department of Health and Human Services (HHS) to discuss this issue on behalf of the National Kidney Foundation (NKF). Four panels of presenters addressed innovation, access and affordability of prescription drugs and the impact on patients, businesses, insurers and governments.
Overall, drug development is progressing rapidly, with 50 new approvals by the Food and Drug Administration (FDA) in 2014 compared with only 20 in 2006. Of the 50 new drugs, 26 were specialty drugs, which typically are much more expensive for insurers and patients. Specialty drugs account for 35% of prescription drug coverage. Some speakers pointed out that although specialty costs have risen dramatically in some cases, it results in more effective care; for example, the number of patients treated for Hepatitis C is six times higher than 5 years ago, but the new medications work for more people with the disease and the treatment is effective for many individuals who would not have benefited from earlier forms of available treatment.
Although specialty and certain other new drugs are increasing prescription drug spending, health industry panelists emphasized that generic versions for many drugs will become available over the next five years as patent protection expires. Generics reduce total costs for a particular drug by 80–90%.
Many panelists focused on the direct patient benefit of new medications not only for improved health outcomes but also benefits such as increased ability to work and improved quality of life. Marc Boutin from the National Health Council (of which NKF is a member) urged the community to view prescription costs as just one part of the broader health system. We must identify what is “value” in the entire system, not only in drugs, and the patient perspective needs to be included in the discussion. Health plans, he argued, need incentives for value rather than incentives to avoid higher cost benefits. Tremendous opportunities exist for new treatments but must be accessible to all patients regardless of their economic status.
We are hopeful that today’s forum will lead to additional discussions among government, industry, insurers and patient organizations to ensure continued development of improved therapies for chronic diseases and ensure patients have affordable access to breakthrough drugs.