Health care costs and affordability remain a major challenge for most Americans, even among those with insurance. According to a March Gallup poll, nearly one-in-five (18%) U.S. adults report that if they needed access to quality health care today, they would be unable to pay for it. The arrival of the COVID-19 crisis has only underscored the challenges facing patients, demonstrating that Americans are in need of a more affordable solution.
Right now, Americans want practical, patient-centered solutions to help them save money and protect future innovation. Below are four solutions that would actually help patients lower their out-of-pocket costs and make what they’ll spend at the pharmacy counter more predictable.
- Improve affordability in Medicare Part D
- Consumers for Quality Care (CQC) found that more than 70% of voters struggle with the unpredictability of out-of-pocket costs and feel like insurance companies are nickel-and-diming them. According to a recent February Morning Consult/PhRMA survey, 80% of Americans support requiring Medicare Part D insurance plans to set a maximum limit for what seniors pay out-of-pocket for prescription medicines each year in order to protect seniors from catastrophic costs.
- Solution: Changes to Part D such as capping annual out-of-pocket payments for prescription medicines, lowering cost sharing, and making those costs more predictable could dramatically reduce out-of-pocket costs for seniors.
- Make insurance work like insurance
- A Public Opinion Strategies (POS)/PhRMA survey found 74% of voters support requiring health insurance companies to be more transparent about what drugs are covered and what patients will pay out-of-pocket for prescription medicines. 82% of Americans support requiring health insurance companies to pass along to patients more of the discounts on prescription medicines they negotiate with pharmaceutical companies.
- According to an October 2020 Morning Consult/PhRMA poll, 87% of voters want to ensure that insurance coverage applies when you need it versus paying hundreds or thousands of a deductible first before coverage kicks in.
- Solution: Across the board, private insurance should work more like insurance is supposed to: spreading costs broadly and providing affordable coverage when people are sick. Insurers should also pass on more savings to patients.
- Protect the safety net
- Safety-net health systems play an essential role in the U.S. health care system by providing care to low-income and vulnerable populations. According to a March Morning Consult/Alliance for Integrity and Reform of 340B survey, 90% of Americans say safety net hospitals in their communities are important. This same survey found 80% of Americans support the 340B program. However, they also believe it needs reform to ensure it is helping low-income, uninsured and vulnerable patients access prescription medicines.
- Solution: Biopharmaceutical companies are advocating for meaningful improvements to the 340B program that ensure patients directly benefit from the tens of billions of dollars in discounts that manufacturers provide.
- End misaligned incentives and enhance competition
- According to recent POS/PhRMA polling, 76% of registered voters support the rebate rule to lower what seniors pay for prescription drugs at the pharmacy.
- A Kaiser Family Foundation poll finds the number of voters in favor of drug pricing negotiations drops sharply when supporters hear that it could lead to less research and development of new drugs (66% oppose) or that Medicare might not cover some prescription drugs (67% oppose).
- March Morning Consult/PhRMA polling revealed 80% of Americans support strengthening the U.S. Food and Drug Administration (FDA) to review and get generic prescription medicines to market faster to increase competition and lower costs.
- Solution: The final rebate rule is a good policy for patients and would help ensure the deep discounts biopharmaceutical research companies currently negotiate with health plans may finally be passed down to seniors at the pharmacy counter.
Let’s fix what’s broken: a health system that limits coverage and increasingly causes the sickest to bear the burdens of prescription medicine costs. America’s biopharmaceutical industry is ready to do our part in working with all stakeholders to deliver a stronger, more resilient, affordable and equitable health care system for all. For a detailed overview of PhRMA’s patient-centered agenda please click here.
Tom Wilbur is Director of Public Affairs at PhRMA focusing on message development and opinion research. Prior to joining PhRMA in 2019, Tom worked on Capitol Hill and on political campaigns for nearly a decade, most recently responsible for communications, campaigns and strategy for U.S. Rep. Fred Upton and the House Energy and Commerce Committee. Tom is a proud Michigander and outside of the virtual office enjoys reading, running, hiking, golfing, and spending time with friends and family.