Ahead of U.S. Department of Health and Human Services (HHS) action earlier this week, drug manufacturers had proposed they would voluntarily modify their advertising to include a disclosure with a web address that consumers could visit for pricing information. But that wasn’t enough for Alex Azar, Secretary of HHS and former pharmaceutical executive. HHS proposed on Monday that it wants full disclosure of the retail list price of a 30-day supply included within the ad itself, on every ad.
The New York Times reports that experts feel this would be misleading to consumers since they don’t pay the list cost. Hold on – I take exception to that. Even though the health plan participant may initially only pay a copayment or even their out-of-pocket maximum, they ABSOLUTELY pay for it in the cost of health insurance. If the plan pays $25,000 for a 30-day supply of a medication, total medical insurance premiums for that company go up by that amount, plus plan expenses. And the plan members sure pay for the increase out of their paycheck.
The American Medical Association (AMA) supports a ban on direct-to-consumer pharma advertising altogether. I don’t agree with that either. Patients should absolutely be made aware that there are new drugs to treat a condition which may impact them, for a lot of reasons; they may not have discussed the condition with their provider, they may be using a current treatment that isn’t entirely effective for them, or let’s face it – doctors aren’t perfect.
The more educated consumers are about treatment options, the better – but consumers need to be a part of the solution. I advocate a legend approach (similar to cigarettes). Consider “The retail cost for a 30-day supply of XYZ Medication is $XX,XXX. Please refer to your health insurance plan or call your insurance carrier to determine what this drug will cost you. Drug costs are a growing component of health insurance costs, which make up a part of your future insurance premiums.” I like that approach.
On October 4, I blogged about Drug Patent Protection – More Low-Hanging Fruit. In that blog I suggested that the manufacturer of Harvoni, Gilead, might be reacting positively to drug pricing concerns by introducing a lower-cost biosimilar version of their drug prior to its patent expiration. This week, I learned at a client utilization review meeting with Cigna the real reason for this drug release. Medicaid and the U.S. prison system pushed back at the more than $90,000 Harvoni price tag and refused to cover the drug. Harvoni is a few years old and much of the known Hepatitis C patients outside these populations have had treatment. Medicaid and prison populations represent an enormous opportunity for Gilead if only the drug were covered…. Presto, magic – the cost goes down almost 75%. Is anyone as outraged as I am about this?!