Drug pricing proposals raise red flags with specialists


White House proposals to help lower drug prices are being met with concerns by a group of specialists.

In a March 14 letter to Department of Health & Human Services Secretary Alex Azar, a group of nine specialty medical organizations highlighted four recent proposals that could have an unintended consequence of limiting access.

The specialty groups that signed onto the letter are the American Academy of Dermatology Association, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Physical Medicine and Rehabilitation, American College of Gastroenterology, American College of Rheumatology, American Gastroenterological Association, American Urological Association, and the Infectious Diseases Society of America.

The groups focused on issues pertaining to four proposals highlighted in the White House’s proposed fiscal year 2019 budget and the February 2018 report from the Council of Economic Advisors titled, “Reforming Biopharmaceutical Pricing at Home and Abroad.”

The first proposal relates to changing the requirement that Medicare Part D prescription drug plans cover at least two drugs per category to covering only one as a way to provide more flexibility and potential negotiation power, while at the same time expanding the ability to use utilization management tools.

“We worry this could create access issues for patients on high cost biologic medications,” the groups said in the letter. “We believe Part D benefits should not limit patients’ access to the medical therapy judged by the treating physician to be the most efficacious choice.”

A pillbox spilling capsules wrapped in paper money ©Dynamic Graphics/Thinkstockphotos.com
The second proposal that is raising concerns calls for shifting some drugs administered in the physician office under Medicare Part B to the Medicare Part D drug benefit. The groups noted this could lead to dramatic increases in out-of-pocket costs, especially for biologics, if the shift were to occur. Magnifying the problem is that Part D offers no additional supplemental coverage to help with the out-of-pocket costs.


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