Payment Systems

The FDA continues to approve novel therapies, but concerns arise due to the costs of certain treatments. To address this, the AMCP organized a forum to explore solutions. Stakeholders recognize the benefits of high-investment medications, but uptake of payment strategies has been slow. Gradual changes, education, and collaboration are essential to improve predictability, affordability, and accessibility for patients.

AMCP believes that a health care delivery system that is based upon a competitive marketplace will provide greater value to patients and payers than a system that is one‐size‐fits‐all that relies on centralized governmental controls and regulatory mandates.

AMCP believes that to provide the greatest value to Americans who need prescription drugs, market forces must effectively ensure that manufacturers of similar drugs compete with one another to establish reasonable pricing levels and maintain consumer access to needed therapies. While government has a responsibility to protect consumers against anti-competitive activity, the government must not establish rules that have the unintended effect of undermining competition.

Medicare Part B pharmaceutical spending has increased rapidly, more than doubling in 2006-2017. Yet, it is unclear whether this increase was driven by increased utilization or increased cost per claim.

AMCP webinar that reviewed proceedings from this Partnership Forum.

Partnership Forum: Participants considered the possible solutions for addressing rising costs and discussed challenges, practical steps for implementing point of sale rebates and other proposed solutions, and discussed how patient assistance programs and copay policies fit into the affordability equation. This forum will develop recommendations and possible solutions to improve price transparency, address the rising costs of medications, and help patient understand and manage drug cost.

AMCP recognizes that many patients today depend on high‐cost specialty medications that often do not have therapeutic alternatives. Medication cost-share offset programs provide out-of-pocket discounts or free product at the point of sale. AMCP is concerned that certain cost‐share offset programs may undermine formulary development and utilization management techniques and can also increase costs for health plans and, ultimately, patients themselves.