Politicians on Capitol Hill are eager to call attention to the high cost of prescription medications. But do policy-makers fully appreciate the unique challenges faced in ensuring affordable access to these vital therapies? ACCP weighed in on the call to Congress to incentivize the integration of qualified clinical pharmacists into value-based patient care teams to achieve better outcomes from the medication therapies so heavily invested in by the nation’s health delivery system.
On Wednesday, March 16, the U.S. Senate Finance Committee held a full hearing titled “Prescription Drug Price Inflation: An Urgent Need to Lower Drug Prices in Medicare.” Finance Committee Chair Ron Wyden (D-OR) highlighted the international price discrepancy faced by U.S. consumers when paying for their prescription medications. Blaming a law that prohibits the federal government from directly negotiating prices with manufacturers, Wyden cited Humira (adalimumab), which is used to treat rheumatoid arthritis, Crohn disease, and other autoimmune conditions.1
During the hearing, Finance Committee Ranking Member Mike Crapo (R-WY) spoke of the dangers of bureaucratic government price controls: “According to a recent study from University of Chicago researchers, innovative R&D [research and development] would decline by nearly one-fifth under these proposed price controls, leading to a staggering 135 fewer new drug approvals in the next two decades.”2 The committee also heard testimony from the following expert witnesses:
- Rena M. Conti, Ph.D., Associate Professor, Department of Markets, Public Policy, and Law, Questrom School of Business, Boston University, Boston, MA
- Douglas Holtz-Eakin, Ph.D., President, American Action Forum, Washington, D.C.
- Stephen Ezell, Vice President, Global Innovation Policy, Information Technology and Innovation Foundation, Washington, D.C.
- Steffany Stern, MPP, Vice President of Advocacy, National Multiple Sclerosis Society, Minneapolis, MN
ACCP does not take an official position on the issue of the prices paid by individual consumers for their prescription drugs. Nor, to its knowledge, have any formal policy or position statements specifically addressing specialty drug pricing methods been published by other national pharmacy or primary care medical organizations.
Instead, as outlined in its 2017 position statement titled “Optimizing Specialty Drug Use,” ACCP calls for enhanced transparency and value-based specialty drug pricing.
Placing sustained emphasis on expanding the underlying evidence base for the overall health system value of specialty drugs remains imperative. Independent cost-effectiveness evaluations and cost-utility analyses can provide clinicians and payers with deeper insight into the potential economic impact of specific treatments as well as their clinical impact. Recent examples include published evaluations of oncologic, cardiovascular, and neurologic treatments. Ongoing investigation must continue in this regard, given the sweeping federal and state health policy changes expected over the next 3–4 years.3
Moreover, ACCP highlights that “the fundamental and historical commitment of pharmacists to ensure the ‘right prescription for the right patient’ requires a significant conceptual reformulation in the particular case of specialty drug decision-making and use.” In particular:
Primary attention to identifying and selecting “the right patient for a specialty drug” using the patient-centered, team-based, and evidence-driven approach of comprehensive medication management must consistently be paired with emerging value-based pricing approaches to better ensure that the rational and economical use of specialty drugs is optimized both for patients and for the health care system.3
During the recent Senate hearing on the increasing cost of prescription drugs, ACCP used this opportunity to urge Congress to enact Section 408: Medicare Coverage for Precision Medicine Consultations of the “Cures 2.0” legislation (HR 6000), which is currently being considered by the House Committee on Energy and Commerce. Section 408 would require the secretary of Health and Human Services to create a pilot grant program within the Center for Medicaid and Medicare Innovation to test approaches to delivering personalized medicine pharmacogenomic consultations by qualified clinical pharmacists.
As the Finance Committee continues to tackle serious issues related to the cost of prescription medications, Medicare coverage, and payment for digital health and personalized medicine infrastructure, Congress must work to advance payment policy to support the integration of evolving team-based, quality-focused payment and care delivery models that shift Medicare payment policy for providers away from volume of services and toward value of care.
Click here to read ACCP’s comments in full.
- Chairman’s News | Newsroom | The United States Senate Committee on Finance – Hearing | Hearings | The United States Senate Committee on Finance – Drugs Watch. April 4, 2022.
- Crapo Statement at Hearing on Prescription Drug Pricing.pdf (senate.gov). March 16, 2022.
- Specialty Drug Use_Final_3.1.17.pdf (accp.com). February 17, 2017.