This week, PCMA released The Path to Patient Affordability, a six-part policy blueprint for federal and state policymakers to make prescription drugs more affordable and transparent for patients and employers.
Politico framed the policies as an opportunity for lawmakers to go beyond the recently enacted PBM reform, writing: “The pitch comes after the practices of PBMs, which negotiate with drugmakers on behalf of a health plan or an employer, were targeted by the Consolidated Appropriations Act earlier this year…”
Behind the six policy principles are concrete steps policymakers can take to lower prescription drug costs.
1. Encourage doctors to use electronic tools that show patients their lowest-cost drug options before they get to the pharmacy
- Adopt interoperability rules and telecommunications standards, so all electronic health records systems can communicate seamlessly.
- Require prescribers to inform patients—when clinically appropriate—of lower-cost therapeutic alternatives, supported by electronic prescribing and real-time benefit tools.
- Adopt rules requiring providers to use such tools to receive payment and require plans in federal health care programs to only reimburse prescriptions generated by electronic systems.
2. Protect the viability of independent retail pharmacies by creating pathways for pharmacists to be paid for the clinical services they provide.
- Enable pharmacists to perform advanced clinical roles
- Authorize tele-pharmacy operations
- Grant pharmacists “provider” status under Medicare Part B during a public health emergency
3. Stop drug manufacturers from using anti-competitive practices like patent thickets to block generic drug competition
- Strengthen state oversight against anticompetitive conduct
- Limit the time in which a drug company can file patents for primary or secondary features, known as “evergreening”
- Limit manufacturers from making incremental changes to a previous product in order to maintain its patent-protected, brand name status known as “product hopping”
- Limit how many patents a company can use in a lawsuit by grouping related patents together
- Limit orphan drug exclusivity to drugs that have no reasonable expectation of recouping development costs through U.S. sales
4. Promote competition by reducing the monopoly period for biologic drugs and allowing biosimilar substitution
- Increase transparency around biologic drug patents and biosimilar adoption through disclosure, education, and Medicaid incentives
- Expand drug substitution flexibility under state law
- Align the biologics eligibility period with small molecule drug
5. Demand transparency for prices and the practices of prescription drug wholesalers and their affiliated companies
- Require pharmacy services administrative organizations (PSAOs) to report national average drug acquisition cost (NADAC) pricing on behalf of independent pharmacies
- Require state tracking of NADAC participation of pharmacies and PSAOs
- Standardize pricing transparency
- Require PSAO licensure
- Prohibit exclusive wholesaler contracts
- Require wholesaler net pricing transparency on pharmacy invoices
6. Rein in Big Pharma’s direct-to-consumer advertisements that drive up costs and mislead patients
- Require list price disclosure in all direct-to-consumer pharmaceutical advertising.
- Require consumer advertisements for drugs and biologics covered under Medicare or Medicaid to include the drug’s list price in all marketing mediums