AMCP Partnership Forum Generates Reform Suggestions for ‘Helping Patients Anticipate and Manage Drug Costs’

Alexandria, Va., March 20, 2020 – Aligning stakeholder perspectives, providing timely and meaningful drug pricing information, and establishing common definitions of health care value could help ensure patients are able to access medications they need at costs they can afford. These ideas and more were generated at the latest AMCP Partnership Forum "Helping Patients Anticipate and Manage Drug Costs," March 12-13 in Alexandria, Va.

“As managed care professionals, our decisions often affect millions of people,” said AMCP CEO Susan A. Cantrell, RPh, CAE. “But we must remember that behind this number are patients who should always be at the center of any considerations around ways to reform health care and lower costs.”

Forum attendees adopted this patient perspective as they examined implications of common drug pricing proposals, including point-of-sale rebates, drug pricing transparency, pharmacy benefit management reforms and copay coupons.

The attendees, who represented diverse sectors including health plans, patient advocacy, employers, integrated delivery systems, PBMs, specialty pharmacies and the biopharmaceutical industry, addressed issues such as understanding patient assistance programs and how copay policies fit into the affordability equation. They also examined ways to ensure greater out-of-pocket cost protection for patients through benefit designs.

In addition, they identified challenges to these considerations, including the United States’ highly segmented health care system and the cost of medicines growing faster than other health care costs. Attendees also noted the difficulty in determining which treatment would be most cost effective for a specific patient within their given plan. In addition, they recognized the significant inefficiencies of the drug and biologics supply chain, some of which yield greater patient cost burdens and suboptimal incentives for utilization of certain therapeutics.

Opportunities for improvement included suggestions to align all stakeholders to place patients in the center of decision making and ensure that any benefit changes or reforms should address patient access, affordability, and adherence. In addition, attendees underscored the need to improve predictability and “smoothing” of out-of-pocket costs to help patients. They also emphasized that portability of benefits and better education at time of selecting benefits will help patients understand their costs and opportunities. Other suggestions from Forum attendees included calls to:

• Ensure that drug pricing transparency information is timely, meaningful, and easy to access. Some attendees noted that it’s difficult for all stakeholders to determine which treatment would be most cost effective for a specific patient within their given benefits plan. Use technology solutions to allow providers to easily access patients’ personalized coverage information, supporting better doctor-patient discussions during an office visit.
• Make pharmacy benefits easier to understand for patients. Patients today are confused about what payments go toward their out-of-pocket expenses, and the relationship between copays and premiums and the effect of copay coupons.
• Consider a nationally recognized measurement of value for therapies. Currently there is no single entity – such as the FDA – that confers a commonly accepted value on a medicine or therapy.
• Modernize regulatory considerations around major health programs. Medicare and Medicaid were designed and implemented more than 50 years ago and have not fully evolved with the changing times and innovations.
• Change many health care sectors. Lowering costs for patients is a multi-dimensional challenge that will require coordination from many stakeholders. Previous business models, which originally worked as intended must be considered for sweeping change if patient-centered health care reforms are going to improve price transparency, address the rising costs of medications, and help patients understand and manage drug costs.

AMCP will create a proceedings document on findings and recommendations from the Partnership Forum, which will be published in an upcoming issue of AMCP’s Journal of Managed Care & Specialty Pharmacy and disseminated widely to decision makers around the country. The AMCP Partnership Forum was sponsored by Merck, Pfizer, PhRMA, and Takeda.