A common complaint about Harvard is that the university is out of touch with the concerns of everyday Americans. This view is supported by recent research from Harvard Business School which suggests that patients should be denied assistance to help them pay for their medications. A Harvard study suggests that in order to control drug costs, the government should eliminate patients’ access to copay programs offered by drug manufacturers. It flies in the face of federal and state efforts to protect the value of these patient assistance programs while ignoring the fundamentals of how and when patients use copay assistance. to access their medicine.
First, the Harvard study suggests that drug costs are a huge problem for the health system if this is not true. The most reliable data on pharmaceuticals indicate that average prices are flat and likely to decrease in the next two years, and that drug company profits will grow in the range of 2-4%, mostly due to increased use by the aging population, not cost. increase gradually. Recent data from SSR Health indicates that drug prices fell nearly 8% last quarter, the largest quarterly decline recorded by SSR.
To understand the current problem of patient payment for prescription drugs, look no further than what insurers and health insurance advocates are doing. All the data suggests that patients are being required, by health plans and their pharmaceutical benefit managers (PBMs), to pay more out-of-pocket for certain drugs to treat more serious illnesses. More and more patients are getting health insurance through their employers in “deductible health plans,” where the average deductible is about $5,000 for an individual and more for the family. While it’s clear that drug prices have fallen, health insurance benefit plans make more expensive so-called “specialty” drugs that treat serious diseases like cancer and multiple sclerosis , and psoriasis. few.
The Biden administration recognized the problem of out-of-pocket costs when they signed into law an out-of-pocket cap of $2,000 in the Medicare Part D drug program. More than a dozen states around the country have enacted policies that prohibit copycat aggregators in the private market, and a bill in Congress would ban such practices at the federal level. government.
In response to the problem of out-of-pocket costs, drug manufacturers have introduced copay assistance programs to ensure that patients can afford the medications recommended by doctors. Study author and Harvard Business School Professor Leemore Dafny is right to say that such assistance should not be offered in cases where a patient uses a brand-name drug when a more expensive discount is available. Even some governments that banned the policies of the hoarders were aware of the widespread practice. But most copays for drugs are nothing like that. Without copay assistance, many patients simply abandon their prescriptions, even for drugs that treat serious illnesses like cancer. When that happens, we know that the bottom line will rise for those who lose control of their condition and need protection.
So, in Professor Dafny’s world, a patient requesting an expensive drug to treat their cancer would have to pay a $5,000 bill before their insurance company would pay a penny.
The good news is that the problem of out-of-pocket expenses is very manageable. Only 1-2% of patients are prescribed an expensive drug that causes cost issues. With improved insurance benefit design, and policies that protect the value of co-pay assistance from pharmaceutical companies, patients have access to the medications they need.
William Smith, PhD, is a senior fellow and Director of the Life Sciences Program at Pioneer Institute in Boston