Concerns about how the Trump administration’s ideas to lower drug prices could reduce patient access to medicines led the ACR to speak out on many different fronts.
On June 25, at a briefing hosted by the ACR and the National Psoriasis Foundation (NPF), a packed room of Congressional staffers and reporters learned from rheumatologists and patients about the challenges involved when patients transition to Medicare. The briefing also addressed how the treatment of chronic conditions, such as arthritis, is being negatively impacted by current drug pricing that could worsen if proposed price changes are enacted, explains Angus Worthing, MD, FACR, FACP, chair of the ACR’s Government Affairs Committee.
Drug Pricing & Treatment Access
“The ways the U.S. drug pricing and drug distribution systems affect our patients are quite complex, and I think we were able to raise awareness on Capitol Hill about how to distinguish between the kinds of reforms that can improve our patients’ access to medicines and those that can worsen access,” Dr. Worthing says.
At the briefing, Dr. Worthing spoke about what a rheumatologist is and how important it is to protect access to breakthrough treatments that have revolutionized rheumatology care, and continue to prevent disability and early death for patients. “I answered questions about the Trump administration’s plans to move Part B drugs into the Part D system, and some of the barriers to the uptake of biosimilars as a way of lowering drug prices.”
Colin Edgerton, MD, FACP, RhMSUS, chair of the ACR’s Committee on Rheumatologic Care (CORC), also spoke at the briefing, and hopes this latest discussion and other dialogue the ACR is leading will help legislators realize the difficulties patients have in accessing treatment. The hope is that these decision makers will incorporate this information into current discussions on medication pricing, such as preserving the Part B program as is, and not following the administration’s plans to transition all or part of the Part B benefit into a system that looks more like Part D.
“The Medicare Part D benefit uses utilization management, such as formularies, fail-first policies, step therapy, prior authorization and cost-tiering, [which] makes it difficult for patients to access biologic medicines for treatment of conditions, such as psoriatic arthritis and rheumatoid arthritis. In contrast, the Medicare Part B benefit does an excellent job of maintaining patient access to these therapies with minimal hassle,” Dr. Edgerton explains.
“It would be a shame for the administration to use these tools to reduce drug prices by reducing access to critical treatments,” Dr. Worthing adds.
Uncovering Medicare Challenges
Each year, nearly 1.4 million Americans transition into the Medicare system and for those with chronic conditions, this transition is wrought with significant healthcare access barriers, such as high-cost sharing, restrictive insurer practices and a broken prior authorization system.
At the briefing, Ms. Kathleen Gallant, a patient advocate and ex officio board member of the NPF, and Mr. John Earley, a patient advocate who serves on the NPF National Advocacy Committee, spoke eloquently about their experiences transitioning to Medicare with a chronic autoimmune disease, Dr. Worthing says, noting that they shared their challenges with high out-of-pocket costs, worries about losing access to medication, testing, specialty care, and the hassles of having to research different plans and budget for all the copayments.
“People shouldn’t be forced to switch medicines when they switch to Medicare, and it should be easy to obtain information in a timely manner about plans and out-of-pocket drug costs,” Dr. Worthing notes. “It’s critical for our lawmakers and policymakers to understand challenges patients face when they transition to Medicare so that they can help fix the flaws and barriers in order to smooth the transition.”
Moving Forward
The ACR does support some aspects of the administration’s drug pricing proposals. For example, the College supports the proposal requiring pharmacy benefit managers (PBMs) to pass negotiated savings on drug prices along to patients, and that pharmacists be allowed and encouraged to inform patients when it’s less expensive to pay cash than to use their insurance, due to high copayments. The ACR is also encouraged by Health and Human Services’ (HHS) suggestion that PBMs should not receive reimbursement (or kickbacks) from drug makers, because they inflate prices and cause formularies to be dictated by money instead of science.
In the coming weeks, the ACR will continue to meet with lawmakers on Capitol Hill and policymakers on Secretary Azar’s team at the HHS, and provide careful comments on administration proposals as they are released.
For More Information
Watch video footage from the June 25 briefing titled “Medicare Access Challenges in the Chronic Disease Community: The Patient Perspective.”
Read more about the briefing.
Carina Stanton is a freelance science writer in Denver.
