WASHINGTON, DC (May 13, 2019): The Council for Affordable Health Coverage (CAHC) – a coalition of employers, insurers, life science companies, PBMs, brokers, agents, patient groups, and physician organizations – announced a bold new set of prescription drug affordability solutions Friday at a Capitol Hill briefing.
"With these reforms, we are giving Congress a road map to save tens of billions of dollars through competition and common sense. Unlike some approaches, our proposals neither harm access nor get bureaucrats or lawyers between doctors and patients. CAHC has done the heavy lifting of bringing stakeholders together across industry lines to rally around solutions that can meaningfully impact patients' costs at the pharmacy counter, as well as overall national health expenditures - now we need Washington to act," said CAHC President Joel White. "Some schemes rely on a government or committee to say 'yes' to access and lower costs. CAHC’s measures save billions by creating powerful incentives and market tools to lower costs instead."
The report, entitled "Prescriptions for Savings: Policies to Increase Patient Access and Improve Affordability for Prescription Drugs" outlines a menu of market-based, cost-saving policy options that fall into the following categories:
Improving coverage: More than 91 percent of people have some form of health coverage, whether private insurance, employer coverage, or Medicare, Medicaid or other public programs. CAHC believes that improvements to health insurance and public coverage will help to lower costs and enhance access. Because patients' prescription drug utilization increases with age, our reforms primarily focus on improvements to Medicare, but will also benefit those with private coverage. These measures include:
Establishing a budget neutral out-of-pocket cap for beneficiaries in Part D that does not raise premiums
Modernizing Medicare Part D reinsurance payments to ensure premiums do not increase
Allowing beneficiaries to pay their Part D cost sharing over time
Allowing HSA qualified health plans to provide first-dollar coverage of prescription drug costs within the deductible.
Paying for Value: For too long, government laws have prevented care coordination and have set pricing floors that prevent deeper discounts. CAHC has been a leader in encouraging reforms that incentivize the uptake of innovative value-based payment models for prescription drugs, which we previously found could save up to $36 billion annually in total healthcare costs. Specific proposals include:
Addressing government barriers that inhibit VBAs in federal programs with clear exceptions to Medicaid best price and Average Manufacturer Price (AMP) reporting and reforms to Stark and Anti-Kickback restrictions.
Creating clear measures of patient outcomes and programmatic successes to be evaluated through a Government Accountability Office study
Spurring Competition: Competitive markets do more to lower drug costs and improve access than government price controls. Our reforms address well-known challenges and get more generics, biosimilars, and brands to market quicker to lower prices and promote choice. Proposals include:
Reducing barriers to generic and biosimilar drug development by passing the CREATES Act
Granting the FDA commissioner authority to expedite approval of a branded drug where there is limited or no competition in a class.
Provide incentives for developing generics in the case of a shortage or significant price increase of a drug
Eliminate pay-for-delay patent settlements
Increasing Transparency: Many consumers have better information available to them about their smartphones than their prescription drugs. Our reforms provide cost information at the point of prescribing so consumers can choose lower-cost options before a prescription is sent to the pharmacy. This includes:
Requiring real-time benefit tools to be used by all Medicare Part D and Medicare Advantage Part D plans by 2021
Requiring plans to show their enrollees the cost-sharing amount and coverage of their medicine before they get to the pharmacy
Speakers at Friday's briefing focused specifically on CAHC's calls for a true out-of-pocket cap for Part D beneficiaries that does not raise premiums, encouraging VBAs for prescription drugs, and increasing transparency with real-time benefit tools.
Read more about CAHC's advocacy work to lower health costs at CAHC.net.