In the U.S., this problem is solved by increasing co-payments and access hurdles for the insured and accepting that a large part of the population is not insured, so in effect has no access at all. In the rest of the civilized world with population health insurance and regulated pricing, the situation is better, but nevertheless society increasingly faces problems to decide where its money is best spent. Given slow or no economic growth, total expenditures are more or less fixed if the deficit is not allowed to grow, so increases in the total healthcare budget will displace other societal expenditures. If the total healthcare budget is not allowed to grow, drug expenditures will displace other necessary health expenditures.
Industry continues to make huge profits from TIM sales. Despite all protestations regarding the high cost of drug development, profits of Big Pharma are up, not down, and your stock broker will advise you to buy their shares. Rheumatologists, professional societies and patients have hugely benefited from the spinoff of the high prices of TIMs: large amounts of money flow to grants and investigator-initiated research, industry roundtables, consultancy fees and support for patient organizations. I’m afraid this has made us look away from the simple, inconvenient truth: prices for these drugs are way too high.
Rather than criticizing research that confirms this, we as rheumatology professionals have a responsibility to help bring the prices down. If they remain at this level, society is better off spending its money elsewhere, to the detriment of our patients.
Maarten Boers, MSc, MD, PhD
Professor of Clinical Epidemiology
Department of Epidemiology and Biostatistics
VU University Medical Center
Amsterdam, The Netherlands
The ACR Replies
We sincerely appreciate the thoughtful comments from Dr. Boers regarding the ACR’s response to ICER’s report on rheumatoid arthritis drugs. We agree that drug prices are too high, and as outlined in our newly revised position statement on Comparative Effectiveness Research, the ACR lauds research efforts to understand which drugs provide the greatest benefit at the lowest cost to patients. Dr. Boers is correct when he states that the potential for misuse of ICER’s report by insurance companies is a “huge concern”: Both government and third-party payers in the U.S. have a long history of enacting policies that delay and impede patient access to medically necessary treatments while patients’ out-of-pocket expenses continue to rise. We also agree with Dr. Boers that, as rheumatology professionals, we have a responsibility to help bring prices down. The ACR has numerous initiatives in this regard, including our Patient Access to Treatment Act (PATA) that has recently been reintroduced in Congress. That said, our proximate concern remains the welfare of our patients, which is threatened by uneven access to life-changing medications. So while the ACR continues its long-term efforts on multiple fronts to reduce drug costs and improve access to care, we remain vigilant for dangers that interfere with our ability to provide optimal care for our patients.