These so-called market-based proposals are nothing more than a litany of new government regulations and mandates that would undermine the competitive market and empower government bureaucrats and insurance companies to make one-size-fits-all treatment decisions for patients.
Rather than address health care costs holistically, these proposals only apply to the small share of health care spending that goes toward life-saving medicines while exempting the largest health care cost drivers, such as hospital charges, which include significant markups for prescription medicines.
Importantly, these proposals would not improve coverage and access for patients, despite recent data showing that out-of-pocket costs are soaring and that insurers are continuing to discriminate against patients with chronic health conditions, such as cancer, diabetes and rheumatoid arthritis.
Five facts about cost and coverage of prescription medicines:
- Prescription drug spending growth is slowing, and spending on medicines is projected to grow in line with overall health care spending through 2024.
- After factoring in rebates and discounts negotiated by payers, net prices for brand medicines increased just 2.8 percent in 2015.
- Out-of-pocket costs for patients are increasing faster than insurer medical costs.
- Many insurers are continuing to discriminate against patients with chronic conditions by putting all medicines, including generics, in the highest cost-sharing tier.
- Data from insurers show prescription drug costs are a smaller share of premium increases than inpatient and outpatient hospitalizations, professional services or taxes and fees. In 2016, the largest driver of premium increases was hospital services.
Robert Zirkelbach Robert Zirkelbach is Executive Vice President of Public Affairs at PhRMA. He joins PhRMA in 2014 after working for seven years representing the health insurance industry. He likes Saturday afternoon BBQs on his deck, traveling, trying new restaurants, and attempting to play golf. He’s an avid, somewhat obsessive, Iowa Hawkeye fan and is lucky to have a wife that loves watching college football on Saturday afternoons.