Healthy Men, Inc. (HMI)—along with most Americans—wants to ensure access to safe, affordable, and effective, medications. Many possible approaches to achieving this goal have been suggested, including those currently in place with the Biden Administration. HMI’s analysis shows that these government price-control-oriented approaches would not achieve meaningful long-term out-of-pocket savings on medications. Instead, rather than relying on transparency, an open market, and true negotiations, the current approaches would create a system that allows the government to effectively set maximum prices for important medications. This type of Federally mandated price control negatively impacts the pharmaceutical industry’s long-term ability to innovate and to “step-up”, as it did in response to the COVID-19 pandemic with vaccines, monoclonal antibodies, and oral medications to treat COVID-19.
HMI believes that those legislators on both sides of the aisle who have carefully read and analyzed the legislation and price-setting approach and who understood the dangers it poses to access, long-term price management, and innovation got it right by opposing those provisions of the BBB legislation. HMI encourages these legislators to stand fast in their advocacy for access and true market-based approaches to managing prescription drug costs and not cave to pressures to change their positions. We encourage the remaining legislators to carefully review the true nature of the approaches being put forward and to reject them.
Government price fixing is not an effective way to lower drug pricing. Instead, Healthy Men, Inc. urges the Biden administration and Congress to pursue other types of free market policies to drive down costs while still maintaining quality care and access to medications. For example, we supported the previous administration’s Executive Order that directed all negotiated savings from pharmaceutical purchasing contracting to be returned to consumers, thereby lowering their out-of-pocket costs.
Given the important impact that this type of pricing policy will have on the efficacy of health care in the United States and the wellbeing of patients across the country, HMI strongly urges policy makers, regulators, and private-sector decision makers to adhere to the following principles that will ensure that proposed reforms will focus on benefiting patients through quality care.
HMI’s Five Recommended Principles for Sound Prescription Medication Pricing Reform
- Prioritize Straightforward and Effective Reforms
Create systems and procedures that are simple, transparent, easily understandable, and effective. This is of paramount importance to restoring patients’ faith in a system that many believe is mysterious, veiled in secrecy, overly complex, and convoluted.
- Ensure That Cost Reductions Are Passed to Patients
Any reforms must honor the tenet that was at the core of the current system: return the lion’s share of cost savings—whether from contract-rates, rebates, price concessions, or anything else—to the patient. The goal of reform should be to reduce patient out-of-pocket expenditures for prescription medications from current levels, rather than just holding the line on costs which are already problematic for many. Returning cost savings to insurance companies and PBMs (most of which are interlaced) or any other entity other than the patient is simply wrong.
- Protect Access to Care
Pricing reforms must not impede access to treatments. A “rob-Peter-to-pay-Paul” strategy, where short-term caps are imposed while at the same time significantly increasing premiums or restricting access has not worked. If caps are instituted, they should be designed in a way to reduce out-of-pocket expenses without compromising other core elements of prescription care or access.
- Preserve the Provider/Patient Relationship
Access to the full spectrum of medications and innovative therapies should not be restricted by limited formularies or a cumbersome trial-and-error process. The selection of therapeutic alternatives must honor the wishes and values of patients within a system that keeps the patient-healthcare provider relationship at the heart of treatment decision making.
- Allow Markets (Not Government) to Reduce Prices
Pricing models and mechanisms should be market based, not dictated by government policies. Establishing arbitrary price targets and using reference standards that don’t meet the needs, wishes, and way of life of American patients undercuts fundamental free-market principles.
These five principles have one commonality: They keep the long-term best interests of patients in focus. In the end, that will fulfill the ethical and social obligations of providers; federal, state, and local governments; and health benefit managers—and will enhance patient care.
Photo by Haley Lawrence on Unsplash
