HHS Forum Invites Dialogue on Prescription Drug Cost and Patient Access

November 23, 2015

by Amanda Conschafter, blog editor

The Department of Health and Human Services’ Friday pharmaceuticals forum assembled a broad range of participants to consider prescription drugs’ costs, effectiveness and accessibility. The forum’s “Addressing Patient Access & the Affordability of Prescription Drugs” panel centered on patient challenges—specifically, barriers posed by pricey medications and poorly designed health plans.

“Out-of-pocket Pain”

The topic of “out of pocket pain,” as moderator Susan Dentzer described patient cost-sharing, featured prominently among panelists’ comments. Consumer Reports Best Buy Drugs Editor Lisa Gill predicted that “consumer outrage and frustration” would ultimately spur better plan designs, noting that plan designs are simply “not fair” and reflect plans’ “own goals.” Marc M. Boutin of the National Health Council echoed the sentiment, acknowledging that “plan designs are not working.”

Specialty tiers came under fire for their complexity and cost-sharing requirements. Debra Whitman, Ph.D., of the AARP noted that even some plans with “catastrophic coverage” out-of-pocket caps still required patients to pay for specialty-tier drugs beyond these caps. An audience member from the AIDS Institute described patients’ confusion over why co-pays varied widely among plans, even for the same drug. Some patients pay $50 for costly hepatitis C cures, he noted, while others are required to pay 50 percent co-insurance. Consumer advocate Heather Block noted that some plans were experimenting with eliminating co-pays for high-value drugs.

Prescription Drug Prices & Innovation

The group also acknowledged the need to drive down prescription drug prices yet still encourage innovation. Ms. Block questioned whether plan design reform was simply a “Band-Aid” for the cost problem, while Dr. Whitman noted that prices would be felt throughout the health care system. Mr. Boutin considered patients’ outlook, speculating that patients sometimes complained about prescription drug prices when what they more accurately felt was simply, “I want access to that drug.” He noted that many diseases still lack treatment options and emphasized the need to encourage innovation.

Affordable Care Act Challenges

Given the current open enrollment period for Affordable Care Act exchange plans, panelists also considered aspects of the health care law. The moderator noted that some ACA plans are “front-loading,” requiring high deductibles before patients can access the coverage they need. In a reference to barriers to hepatitis C cures, an audience representative of the AIDS Institute noted that “it’d be great if HHS could enforce the non-discrimination provision” of the law.

For more, see www.hhs.gov/hhspharmaceuticalforum.

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