Senator Wyden’s proposal falls far short in pursuit of success on pressing health care needs today and into the future
July 8, 2021 (WASHINGTON, D.C.) The Partnership to Fight Chronic Disease (PFCD) today released the following statement on the recent principles for reform set forth by Senate Finance Committee Chairman Ron Wyden (D-OR):
“We agree that reducing the cost of prescription drugs for patients is an important goal. While the Chairman's stated goal is to produce a consensus proposal that can pass both chambers of Congress, the principles and subsequent statements closed the door on bipartisan efforts and opened it to more radical changes that lack bipartisan, bicameral support.
Six in ten Americans lives with at least one chronic condition, and four in ten live with two or more. People covered by Medicare and Black and Brown Americans are disproportionately affected by chronic illnesses. These individuals and their families need access to the treatments that can help to best manage their medical needs and reliable coverage for the care that could better prevent these conditions in the first place. Out-of-pocket costs and coverage restrictions including fail first policies severely limit access, but Senator Wyden’s principles largely fail to address those issues. For millions of others living with chronic conditions, treatments are limited or non-existent and accelerating innovation is critical. The principles could have a profound impact on medical innovation and delay or eliminate relief for millions with unmet medical needs.
Senator Wyden’s principles call for greater government intervention that would undercut resources required for innovative research and development and harm patients resulting in fewer new medicines developed over the next decade.
Removing the protection that prohibits the government from price setting, known as the non-interference clause, will open the door to access restrictions in Medicare. As the Congressional Budget Office has stated, the only way to derive savings from removing the non-interference clause is through a national formulary or restricting access to medicines. What Americans suffering from one or more chronic disease need now more than ever is the ability for their provider, not the government, to determine what therapy or treatment is right for them. Senator Wyden’s proposal would allow government bureaucrats to interfere with a patient ’s and his or her provider’s decisions on treatment.
We agree with the principle that singles out misaligned incentives including the need for drug rebate reforms as an essential area for attention. Three PBMs—Optum Rx, Express Scripts and CVS Caremark—control 77 percent of all prescription claims managed in 2020 and are among Fortune’s top 25 companies in the US.[1] They do not need government protection or assistance in negotiating deals on drug prices. Other efforts to reduce patient costs, such as capping out-of-pocket costs in Medicare Part D, however, would be tremendously helpful, but welcome reforms were not included in the principles as currently drafted.
Out-of-pocket costs are a major barrier to affordable access to medicines. The rise in high deductible health plans, PBMs and insurers collecting coinsurance and deductibles from patients based on list prices of drugs, and the growth of co-pay accumulator policies have increased patient cost sharing for medicines significantly. In fact, the Partnership to Fight Chronic Disease developed a framework to address the high cost burdens[2] facing people with serious chronic conditions and jointly penned a Health Affairs blog[3] that described the challenges facing patients and highlighting solutions to address them. Senator Wyden’s principles do not address these access challenges for patients – with the exception of calling for rebate reforms as noted above.
We are witnessing the power of medical innovation in real time. The availability of COVID-19 vaccines and treatments has led to significant reductions in COVID-19’s impact, particularly within populations hardest hit – older Americans, Black and Brown Americans, and people living with chronic conditions. Continued medical innovation is a critical component of improving health and promoting health equity in America. Finding ways to encourage innovation while improving equitable access is critically important but requires careful considerations of unintended consequences that threaten the gains we’re seeing today, and hold promise of being realized tomorrow. Price controls, undermining patent protections, and related government interventions to pass judgment on “value” and set prices are not the way forward.
Chronic disease impacts nearly every American in some way, be it as a patient, caregiver, loved one or coworker, and it costs the U.S. an estimated $3.8 trillion annually. The past year has presented particularly difficult challenges to continuity and coordination of care for those with chronic disease. While still navigating out of the pandemic of a lifetime for most Americans, it is critical to keep the focus on how to prepare for and prevent future health crises that could compromise lives and our economy.”
[1] The Top Pharmacy Benefit Managers of 2020: Vertical Integration Drive Consolidation. April 6, 2021. Available online at https://www.drugchannels.net/2021/04/the-top-pharmacy-benefit-managers-pbms.html; Fortune 500. Available online at https://fortune.com/fortune500/.
[2] Partnership to Fight Chronic Disease. Framework to Address High Cost Burden for People with Serious Chronic Conditions. Available online at Framework to Address High Cost Burden for People with Serious Chronic Conditions | Keeping Education ACTIVE | Partnership to Fight Chronic Disease.
[3] KE Thorpe, K Calder, A Hyde, L Weidner. The Challenges of High-Deductible Plans for Chronically Ill People. Health Affairs Blog. Apr. 22, 2019. Available online at The Challenges Of High-Deductible Plans For Chronically Ill People | Health Affairs.