Affordability Is About More Than Drug Prices

A new study published by the National Pharmaceutical Council (NPC) and Xcenda found that potential government involvement in drug pricing would be unlikely to increase patient affordability. The research suggested that reforming health benefit designs would be a better approach to truly address affordability concerns for patients and the overall health system.

Key takeaways from the research, which surveyed 35 decision-makers at national and regional health plans, integrated delivery networks and pharmacy benefit managers about what changes might take place if government price regulation lowered total drug costs (i.e., the costs for all drugs) by 15%, include:

• No significant impact on copay and coinsurance amounts:
  • Only 1 of 4 respondents said they would pass savings to patients in the form of lower copays, and the vast majority of payers indicated that the coinsurance rate would not change. Most interviewed said that no discount amount would trigger a drop in copays or coinsurance rates.
• A potential drop in premiums:
  • Almost half of respondents said a 15% price cut could lead to lower premiums for plan sponsors and patients. Given concerns around affordability by plan sponsors, savings from drug price controls could be used to reduce premiums while keeping benefit designs unchanged.

• No impact on Part D coverage:
  • Almost 3 in 4 respondents stated that a 15% reduction would be unlikely to change or broaden Part D coverage for branded medications on their organization’s formulary.

"The survey shows that price controls won’t help patients or reduce their out-of-pocket costs,” said Robert Dubois, MD, PhD, NPC Chief Science Officer and Executive Vice President. “As other studies have shown, they will harm innovation.”

The study concludes that savings from government price action are unlikely to be shared through reduced premiums and are unlikely to help patients with onerous cost-sharing requirements that result from the widespread use of coinsurance. In addition, as long as rebates continue to be prevalent, government pricing efforts are unlikely to have a significant impact on coverage and patient access.

The full study, Affordability Is About More Than Drug Prices, is posted on Xcenda’s website.