As family physicians counsel their patients on the best treatment regimens, sometimes that means turning to expensive prescription drugs.
This week, the AAFP threw its weight behind efforts to push back against drug price increases by joining the Campaign for Sustainable Rx Pricing(www.csrxp.org) (CSRxP). The campaign is a nonpartisan coalition of organizations -- including nonprofit medical associations, insurers and hospitals -- that seeks to strike a balance between innovation and affordability in the pharmaceutical industry.
"As physicians, our work focuses on ensuring our patients have access to the highest quality of care, including the prescriptions they need," said AAFP President John Meigs, M.D., of Centreville, Ala., in an April 6 announcement about the move.(www.csrxp.org) "We're pleased to join a national dialogue that ensures both innovation and affordability of medications. Working together, we can find a solution."
- The AAFP announced April 6 that it has joined the nonpartisan Campaign for Sustainable Rx Pricing.
- Spending on prescription drugs is growing faster than any other health care expenditure segment.
- The campaign released a detailed proposal of potential solutions to the problem of skyrocketing drug prices.
The campaign compiled grassroots videos of voters across the country telling personal stories of skyrocketing drug prices to members of Congress and candidates from the past presidential election cycle, and it has released a detailed proposal(www.csrxp.org) of potential solutions to the problem. Family physicians are critical to the effort.
"AAFP's members are the front line of medical care in this country and are forceful advocates for the patients that they serve," said CSRxP Executive Director John Rother. "The AAFP brings a unique perspective and voice to our partnership that represents nearly every aspect of health care in the United States."
Spending on prescription drugs is growing faster than any other health care expenditure segment. In 2015 alone, prescription drug prices rose 7 percent, the highest one-year increase since 1992. Although pharmaceutical companies often justify high prices by saying they offset research costs, the campaign noted that such claims are impossible to verify. Moreover, nine of the 10 largest drug makers spent 50 percent more on advertising than on research and development.
To illustrate the disconnect between prices and development costs, the campaign noted that the hepatitis C drug sofosbuvir (Sovaldi) was developed by Pharmasset, a small company whose primary funding came from the NIH. Yet despite taxpayers having largely footed the bill for developing sofosbuvir, when Gilead purchased Pharmasset, it set the price of the drug at $1,000 per pill -- $84,000 for an entire course of treatment.
U.S. citizens have the highest out-of-pocket health costs in the world, and high drug costs are contributing to that statistic. For example, the price of a two-pack of EpiPen epinephrine auto-injectors rose from $94 in 2007 to $608 this year, insulin prices have tripled during the past seven years, and statins that used to cost as little as $5 now go for $50.
Drug makers often maintain high prices using the tactic of extending patents by introducing "new" products that may simply be extended-release formulations of old products or combinations of existing therapies. They also pursue litigation or offer financial settlements with generic manufacturers to delay market entry of generic drugs. The FTC estimated that such delays cost consumers $3.5 billion annually.
In its proposal, the campaign said greater transparency and stronger regulatory enforcement can help bring drug costs under control. Manufacturers should be required to disclose to government agencies the maximum price they intend to charge for a new drug and the total cost of treatment. Insurers already operate under a similar rule that requires them to submit premium information to state insurance commissions months in advance and to publicly justify rate increases greater than 10 percent.
The proposal also calls for drug manufactures in the United States to present evidence of the effectiveness of new drugs, as they do in other nations. Such a move would help physicians and patients know how treatments and drug regimens should be valued. The campaign cited the example of protein convertase subtilisin/kexin type 9, or PCSK9, inhibitors used to treat high cholesterol, which analysis by the Institute for Clinical and Economic Review found should cost between $3,600 and $4,800 per year instead of the $14,000 manufacturer's price.
To foster greater competition, the campaign advocates expedited entry of generic drugs to the market. The FDA has a backlog of nearly 4,000 applications for generic drugs, and approval takes three to four years on average. The proposal said the FDA should be given resources to reduce this backlog.
And major savings could lie in changing the law to allow CMS to negotiate directly with drug manufacturers.
Finally, the proposal calls for programs that require innovative payment and incentives that promote value such as the 340B Drug Pricing Program, which allows clinic patients to obtain medication at significantly reduced prices.
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