Just when we thought spring might be around the corner, a second nor’easter comes along (no need to be smug West Coast readers, we know you’ve got the sun). While many of you took a well-deserved snow day, The Week That Was team was glued to our computer screens because this storm brought just as much healthcare news as it did precipitation. Here’s the accumulation:
And please join us in welcoming to The Week That Was team, Peter Pitts. Pitts, a former associate commissioner at the U.S. Food & Drug Administration and President of the Center for Medicine in the Public Interest, joins Syneos Health’s Reputation & Risk Management Practice as a senior policy consultant advisor. Check out Peter’s take in Investor’s Business Daily this week on what the Administration has done right on drug pricing relative to campaign rhetoric.
With more storms on the weathercast, batten down the hatches and read on for more of The Week That Was...
►THE BUCK STOPS WHERE?
We opened the week with, well, nobody looking good. A feature story, co-authored by The New York Times and ProPublica, profiled a number of patients who attributed their inability to afford lifesaving medications either to insurer coverage denials or to falling through the cracks of manufacturer and governmental financial assistance programs. And all this happening as a Wells Fargo analysis shows drugmaker discounts on drug list prices grew to 41% last year, as compared to 28% in 2012. So with more discounts, why is affordability for some harder than ever? Many would argue that a contributing factor is that the rebates, which pharmacy benefit manufacturers (PBMs) receive from medicines companies, are often not passed on to the consumer.
Enter stage right: UnitedHealth. Tuesday morning, in an effort to “reduce costs for patients and promote transparency,” UnitedHealth Group announced that the rebates it receives from drugmakers will be passed to patients. It estimates ~7.5 million people covered under UnitedHealth will see reduced costs, ranging from a few dollars for some to thousands of dollars for others. While a step in the right direction, this announcement won’t impact their 18.6 million members who are insured through employer-based plans, which represent the majority of its members. UnitedHealth has previously given employers the option to release rebates directly to patients, yet only 4% of employers have opted in.
Is UnitedHealth Group’s announcement tantamount to the insurance industry’s version of the pricing pledge? Maybe. With pressure from the pharmaceutical industry’s Share the Savings campaign, heightened Congressional interest in drug affordability as mid-terms approach, and corporate America taking drug affordability into its own hands, it’s certain that the need to take action has been mounting. But will it be the cure to drug pricing? Not really. UH’s pledge doesn’t solve the issue of rebates for many patients. And, some experts suggest that passing rebates directly to some consumers could result in increased premiums, thereby negating any “savings” consumers see from rebates.
In the meantime, life sciences companies will continue to see scrutiny on high list prices, and arguments that deflect blame to insurers or PBMs may fall flat amidst a potential wave of future payer transparency. Drug companies must continue to demonstrate efforts to help patients in high-deductible plans and those who are un-insured and underinsured.
►THE FORGOTTEN FACE OF PAIN
Our proprietary research has shown that media coverage of opioids has increased three-fold in recent years, yet the voice of the pain patient is often missing. In a “war” against opioid abuse, unsurprisingly, patients with legitimate pain are feeling unheard and victimized, reporting that they feel attacked and that their pain is illegitimate. Last Monday, moments before the Centers for Medicare and Medicaid Services would announce a proposal to restrict opioid doses for Medicare patients to 90 mg a day, a coalition of doctors, pain patients, and public health experts emerged to object. This coalition – which has since grown to include academics and editors of pain journals – state that the proposed rule is an overreach by CMS into individual patient medical treatment, takes decision-making power away from physicians, and intrudes on a chronic pain patient’s right to effective treatment.
In the national effort to address the opioid epidemic, blunt policy measures may risk oversimplifying a diverse patient population that can’t be easily bracketed into care. Policymakers must account for the fact that people battling addiction and people diagnosed with chronic pain are all affected by the protocol changes with opioid prescriptions. Another significant aspect of last week’s move is the fact that Coalition didn’t stay quiet at a moment when pain therapy advocates have faced greater public pressures. Recent efforts that have included investigations by Senator Claire McCaskill, which have claimed that some advocacy groups were “influenced” by pain makers. In such moments where integrity is getting questioned, staying silent against a government policy would be the easiest course. In a national fight to prevent untimely deaths from addiction, we must remember that proposing binary solutions and laying blame is simple - developing real, meaningful solutions is the hard, needed work that lies ahead.
Until next week,
- The Reputation & Risk Management Practice @ Syneos Health Communications