March 29, 2017
(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) today released the following points regarding a new PhRMA report on patient out-of-pocket spending:
- According to the Centers for Medicare and Medicaid Services (CMS), the average amount spent out-of-pocket for drugs continues to decline, projected to be 13% of drug spending in 2016, down from 23% in 2006.
- Rising drug costs is a pricing problem, not a coverage problem. Health plans don’t have unlimited funds to pay first dollar coverage on every drug, regardless of its price.
- The simplest, most obvious way for drugmakers to reduce costs and improve access is to cut their prices.
- The report ignores the most obvious and important point: rising out-of-pocket costs are a by-product of rising drug prices and the wave of new high-priced specialty brands coming to market.
- While not all health plans apply manufacturer rebates to reduce cost-sharing on each drug, it’s usually because the savings are being used to reduce premiums.
- Higher cost-sharing on certain brand drugs is often used to promote less expensive but equally effective generics, which comprise almost 90% of prescriptions.
- The employers and unions that offer coverage know better than the drug industry what’s best for their patient populations. Whether health plans decide to reduce costs by reducing premiums for all or cost-sharing on certain drugs should be up to them – not drugmakers.