Academy Calls for Drug Pricing Transparency, Action

AAFP Praises SPIKE Act, Encourages Ongoing Insulin Cost Investigation

April 17, 2019 01:24 pm News Staff – Type the word skyrocketing into a Google search and some of the top autofill suggestions (besides helpful synonyms) include a couple of familiar items that are indeed ballooning, snowballing and swelling: pharmaceutical costs and insulin prices.

This isn't news to family physicians' patients, as the Academy noted in two recent letters to lawmakers.

"Skyrocketing drug costs displace family funds for other priorities, including nonpharmaceutical primary care," the AAFP said in an April 8 letter(2 page PDF) supporting the Stopping the Pharmaceutical Industry From Keeping Drugs Expensive (SPIKE) Act, a recently introduced House bill intended to arrest increases in prescription drug costs.

"We are hopeful that if the SPIKE Act becomes law, it will reduce the cost of prescription drugs for family physician patients," the letter told the bill's sponsors, Reps. Steven Horsford, D-Nev., and Tom Reed, R-N.Y. It was signed by Board Chair Michael Munger, M.D., of Overland Park, Kan.

The Academy's correspondence cited a 2018 survey in which 44 percent of respondents reported they didn't see their doctor when they were sick or injured because they could not afford a visit, and 32 percent said they were unable to fill a prescription or took less than the prescribed dose because of its cost.

The bill -- modeled on insulin cost legislation that became law in Nevada two years ago -- would require pharmaceutical manufacturers to report detailed information to HHS for certain drugs when prices exceed set thresholds. Manufacturers also would have to submit written justification for a price increase or a high launch price.

The Academy's letter praised four key components of the bill:

• requiring the disclosure of significant drug price increases;
  
• linking these disclosures to the Consumer Price Index;
  
• disclosing the percentage of price increases linked to federally funded research and development, as well as to the manufacturer's total spending on research, development, marketing and advertising; and
  
• imposing penalties of $10,000 per day for delaying disclosure and $100,000 for giving false information.

A comparable bill in the Senate that bears the same name and also was introduced this session would require drug companies to submit similar cost notice and justification to CMS for publication.

The AAFP's letter closed by calling on lawmakers to also "examine the administrative burdens associated with health care and drug prescribing, such as prior authorizations and step therapy."

The Academy followed the correspondence on the SPIKE Act with an April 9 letter(3 page PDF) that focused specifically on rising insulin prices.

Noting that "access to affordable insulin is a serious concern among America's family physicians," the letter to Reps. Diana DeGette, D-Colo., and Brett Guthrie, R-Ky. -- the chair and ranking member of the House Energy and Commerce Committee's Subcommittee on Oversight and Investigations, respectively -- encouraged ongoing examination of "the factors causing high insulin prices."

"The lack of a transparent, regulated market allows for profit-centric decisions that place patients and their health care needs behind the financial needs of companies and shareholders," stated the letter, also signed by Munger.

The correspondence included testimonials from family physicians, including an AAFP member from Virginia who said, "Insulin pricing is a problem that has been worsening for my patients for the past several years but has really accelerated over the past two years or so. I frequently have to use insulin regimens which were state of the art 20+ years ago but tend to be more complicated and much more confusing for the patient than today's standard."

The letter noted that, between 2010 and 2015, "the monthly wholesale price of Humulin, the most popular insulin, rose to nearly $1,100, up from $258 for the average patient."  

"Our patients are increasingly struggling to afford their insulin and are, therefore, unable to follow their treatment plans. This inability is not their fault but is directly correlated with insulin price," the letter added, pointing out that the health and longevity of many patients depends on their ability to follow treatment plans.

Related AAFP News Coverage
Six Physician Groups, One Lane
Recommendations Aim to Shape Health Funding, Drug Pricing
(2/11/2019)

AAFP Calls for Wide-ranging Approach to Lowering Drug Prices
Academy Urges HHS to Boost Access to Generic Drugs, for Starters
(7/24/2018)