A Tale of Two Drug Codes
October 31, 2019
Two isn’t always better than one. Just ask patients caught in the confusion of two national drug codes for the same cholesterol-lowering medicine.
A national drug code is a unique string of digits used to identify a medication for billing. In the beginning, an innovative PCSK9 inhibitor for treating stubbornly high cholesterol had just one. Then the drug’s manufacturer dropped the price by 60%. Despite being the same medication – just at a lower price – the medication was then assigned a second code.
That became a problem for patients. In fact, having two codes undermined the benefit of lowering prices for the cholesterol-busting medicine in the first place.
The price drop was intended to reduce the number of insurers denying patients access to the treatment because of price. It also should have made the medicine more affordable for patients, whose out-of-pocket expense is often tied to the medicine’s price. A lower list price translates to a lower co-pay. And a lower co-pay both decreases the likelihood that patients will abandon their prescription at the pharmacy counter and increases the likelihood that they will take the medicine as prescribed. All of this feeds into the larger goal of protecting patients from avoidable heart attacks and strokes, which new research shows is more likely when patients can obtain their PSCK9 inhibitors.
Yet some health plans chose to offer the PCSK9 inhibitor only under its original, higher-priced drug code. Some blamed bureaucratic red tape for delaying their ability to offer the drug under its new, lower-cost code. Rebates for pharmacy benefit managers may also have been a deterrent, since higher list prices can shore up higher rebates for a health plan’s middleman.
So the manufacturer found a simple solution. Starting in January 2020, the manufacturer recently announced, it will sell its PCSK9 inhibitor at the lower price point only.
Here’s to ringing in the New Year with a lower list price and better access to cholesterol-lowering medicine.
Categorized in: Blog