In a world of continual innovation in biopharmaceuticals, how do we ensure patients have access to the medicines that work to meet their individual needs?
On Day 1 of BIO’s Patient and Health Advocacy Summit, a group of health care stakeholders joined Merck’s Dr. Julie Gerberding for a discussion about the importance of understanding policies that may stand between patients and the treatments they need. Panelists included:
- Carl Schmid, The AIDS Institute
- Donna Cryer, Global Liver Institute
- Alan Balch, Patient Advocate Foundation and National Patient Advocate Foundation
- Anna Hyde, Arthritis Foundation
The group touched on topics ranging from the acceleration of high patient cost-sharing and barriers to patient assistance programs, including co-pay accumulators, to the adoption of utilization management tools like step-therapy, and the drive toward using cost-effectiveness analyses in coverage decisions.
Early in the discussion, Carl Schmid was asked about co-pay accumulator programs and the challenges they pose to patients and consumers. “These policies are usually buried in the plan documents, so people don’t even know that they are being subject to this practice,” he told the crowd.
As he explained, insurance plans and pharmacy benefit managers (PBMs) have started to implement these policies which prevent funds provided by financial assistance programs offered by drug manufacturers from applying to a patient’s out of pocket maximum or deductible. This can leave patients with steep costs when the value of patient assistance is exhausted. “We’re very concerned that it could impact adherence and lead to people not picking up their drugs,” he concluded.
Next, Donna Cryer shared her concerns about step therapy and explained why this policy – often referred to as “fail first” – could be dangerous for patients. “Step therapy requires that you try a drug that is something different from what you and your doctor have agreed upon,” Cryer explained while providing detail about this practice, which is used as a tool to drive a patient towards a lower cost treatment. “It is well documented in literature that patients who are subjected to step therapy or fail first utilization management tactics experience delays in care … and that is not appreciated,” she added.
To close out the session, Dr. Gerberding initiated a discussion on the Trump Administration’s American Patients First Blueprint. While the group agreed that the proposal is far from perfect, Dr. Alan Balch noted that we must “identify the pieces that we think are beneficial and will help patients, and then extrapolate … them across the board.” Balch continued, “it’s not enough to only give patients access to information about drug prices … it’s their surgery costs, diagnostic tests, hospital costs” that need to be shared as well. “There must be a common denominator, so everyone is playing under the same set of rules.”
Anna Hyde with the Arthritis Foundation echoed these comments, adding that “while we talk a lot about patient impact and patient centeredness, there is a shift in thinking that hasn’t happened yet. Not enough people who develop and implement policy ask themselves the questions of ‘What is the impact to the patient? Is this going to be a net benefit to the patient?’” On how to make that shift happen, Hyde concluded “every piece of the ecosystem” has to think about these questions, “not just the patient community, but the provider community, the pharmaceutical community, [and] the payer community … so that it becomes a more standard way of thinking.”