There has been a growing clamor among a wide range of healthcare and policy stakeholders for drug pricing transparency and pharmacy spend cost containment.
The number of legislative initiatives and voices across Government and on the campaign trail on these issues reflect this heightened interest and focus. That’s good news for everyone responsible for the delivery of health services and benefit coverage, and especially for every person that needs these medicines, often life-saving drugs.
One recent bill, the “Public Disclosure of Drug Discounts and Real-Time Beneficiary Drug Cost Act” (H.R. 2115), which has passed the U.S. House of Representatives and is under review by the Senate, seeks to provide greater clarity on the pharmacy supply chain factors that influence drug pricing. The legislation also calls for sharing by pharmacy plan providers of consumer drug benefit cost information with their doctors as well as expanding the use of consumer drug pricing tools and platforms.
The legislation states as its purpose that “in order to allow the comparison of a PBM’s ability to negotiate rebates, discounts, direct and indirect remuneration fees, administrative fees and price concessions” -- and their amounts --that are passed through to employer plan sponsors, HHS will publish PBM generic dispensing rates. This may provide clearer insights into drug prices and pharmacy benefit managers performance.
The legislation also calls for the integration of employee plan real-time benefit technology tools and information with their prescribing doctors’ electronic prescribing and record systems (EHR). This is more likely to increase transparency in the drug price conversation, at least between doctors and their patients. This would ensure that physicians and other care providers receive a patient’s drug plan coverage information before or at point of care, enabling them to prescribe medicines at the lowest price that are covered by their plans.
Armed with real-time benefit information, physicians can quickly identify whether a prior authorization (PA) request needs to be made with a patient’s PBM or health plan, or if the patient has high copays for a drug they prescribe. They can then work with patients to select lower priced options. This would improve patient-doctor communications around their care options and enhance the trusted relationship between them, something often missing. It would also prevent patient sticker shock at the retail pharmacy counter for being a prescribed a medication that has a high copay and/or needs a PA or is not covered under their plan at all. All of these scenarios can increase the likelihood that the patient will abandon their prescription.
Meanwhile, pharmaceutical manufacturers can also provide relevant data and insights to employers and health plans on which medicines pharmacy plan members are choosing to purchase based on price sensitivities. In fact, there is probably no better time than now for pharma, employers, and health plans to collaborate on innovative ways to secure the widest access possible for getting critical drug treatments into the hands of consumers.
H.R. 2115 brings attention to the drug price transparency issue. We will continue to keep an eye on where this bill goes, but no matter the result, employers and health plans must insist on the most transparent drug benefit pricing possible so consumers can make informed choices for managing their healthcare costs. Employers and health plans should work closely with their PBMs to educate plan members on how to access their pharmacy benefit information in real-time and the drug pricing tools that are available to them.
Likewise, drug manufacturers also have a unique opportunity to partner with employers and health plans on educational initiatives around medication treatment options for members.
To find out how we help drive transparency across the entire pharmacy supply chain, contact us at email@example.com.