Lancaster Physician Spring 2017 - 24

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Patient Advocacy

Table 1
CHARACTERISTICS OF
SPECIALTY MEDICINES


COST GREATER THAN $750/MONTH



TREAT A RARE CONDITION



REQUIRE SPECIAL HANDLING



REQUIRE SPECIAL MONITORING
USED IN LIMITED DISTRIBUTION
NETWORKS (available from a limited
number of pharmacies)



There are several reasons why manufacturers and insurers use the specialty pharmacy
model for certain medications: easier access
to data, compliance with specific monitoring
and education requirements, and easier
management of copays. As of 2016, specialty
medications account for 40 percent of all
prescription medication spending in the
United States, and that figure is growing.8
Some examples of specialty drugs that are
causing the most spending are HUMIRA®,
Enbrel® and Remicade®, each with sales
estimated to be over $4 billion in 2018.9
Hepatitis C provides an interesting perspective on how specialty pharmaceuticals are
impacting drug spending. Hepatitis C can
now be cured. This dramatic development
comes at a high cost-in some cases as much
as $100,000 for a complete course of medications-which is covered to some degree
by health insurers and Medicare, though not
by some state Medicaid programs. Patients
are responsible for copays, which can be
substantial, and for many patients, unaffordable. The drug manufacturers, responding
to intense public pressure, have offered a
variety of programs providing assistance to
those who cannot afford the drugs.

POTENTIAL SOLUTIONS
Management of the rising cost of medications will depend upon a combination of
changes and transparency. Dialogue between
patient and provider around the impact of
medication costs is an important variable
in managing the patient's care.

The following suggestions for reducing
the rising costs of medications at a national
level are shared by many thought leaders:
Direct-to-consumer advertising for
pharmaceuticals should be banned. This is
a recommendation supported by The American Medical Association and the American
Society of Health System Pharmacists. Pharmaceutical companies spent $5.4 billion on
direct-to-consumer ads in 2015.10
The practice of "pay-to-delay" should be
eliminated. This is a maneuver that manufacturers of brand-name drugs use to delay
competition from generic products.
Eliminate and replace copay assistance
cards and programs. While in the short term,
these reduce a patient's out-of-pocket copay,
they encourage the use of brand medications
over lower-cost alternatives. Those costs are
still paid ultimately by patients' insurance
premiums and by their employers.
The FDA should establish a process to
allow the importation of medications on a
case-by-case basis when the medication has
been impacted by significant price increases.

CONCLUSION
This review of the drivers of drug cost
inflation, with some specific examples of
each, provides a background for understanding the increased cost of medications
in the United States. There are many more
examples for each category, but each would
follow the same playbook.
To best manage and optimize care of
patients, physicians must have an understanding around how the rising costs of
medications impact patients. This allows for
partnering with patients so prudent decisions
can be made based upon the resources and
access the patient has for medications. The
primary driver for medication selection will
always be what is best for the patient, but
fulfilling that objective is becoming more
complicated as we continue to see dramatic
increases in the costs of medications.

LANCASTER

24

PHYSICIAN

References

1 www.imshealth.com/en/about-us/news/
ims-health-study-us-drug-spending-growth-reaches8.5-percent-in-2015
2 http://www.fda.gov/drugs/guidancecomplianceregulatoryinformation/enforcementactivitiesbyfda/
selectedenforcementactionsonunapproveddrugs/
default.htm
3 www.bloomberg.com/news/
articles/2015-10-06/2-000-drug-price-surge-is-aside-effect-of-fda-safety-program
4 IMS Institute for Healthcare Informatics.
Innovation in Cancer Care and Implications for
Health Systems. May 2014. www.obroncology.
com/imshealth/content/IMSH_Oncology_Trend_
Report_020514F4_screen.pdf.
5 http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.737.256&rep=rep1&type=pdf
6 www.curetoday.com/articles/survival-benefit-with-opdivo-sustained-in-squamous-nsclc
7 Kazi DS, Moran AE, Coxson PG, et al. Cost-effectiveness of PCSK9 inhibitor therapy in patients
with heterozygous familial hypercholesterolemia or
atherosclerotic cardiovascular disease. JAMA 2016;
316:743-753
8 www.imshealth.com/en/about-us/news/
ims-health-forecasts-global-drug-spending-to-increase-30-percent-by-2020.
9 Pembroke Consulting Analysis of World Preview
2013, Outlook to 2018. EvaluatePharmacy, July
2013. Published on Drug Channels (http://www.
drugchannels.net) on August 13, 2013.
10 http://adage.com/article/advertising/
top-200-u-s-advertisers-spend-smarter/304625/


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