In case you missed it, Express Scripts, the nation’s largest pharmacy benefit manager, announced that it will include two new cholesterol-lowering medicines, called PCSK9 inhibitors, on its national list of covered medicines thanks in part to substantial – and typical – discounts negotiated. According to the company, “we were able over the course of tough negotiations to get good economics on both products.”
That’s because our nation’s competitive marketplace works to control costs while encouraging the development of new therapies.
This decision is in marked contrast to the doubt Express Scripts expressed this summer on whether they could afford to cover both new drugs and claims that the medicines could “wreak financial havoc” among its clients.
We saw a similar narrative play out last year when Express Scripts and other payers claimed new hepatitis C treatments with cure rates of more than 90 percent would be unsustainable and that “the burden will fall upon individual patients and federal governments, and payers, who will have to balance access and affordability in a way they never have had to before.” We all know how that story ended - “the price is sufficiently low that we can go to our clients and say that they can treat every patient with hepatitis C.”
How does this keep happening?
While the price of a drug may increase or decrease over its lifetime, prices fall dramatically as competition occurs among brand-name medicines and even further with the introduction of generics. Innovator companies invest in research to develop new medicines, and over time they become available as lower-cost generic versions - typically up to 80 percent less. And all the while, pharmacy benefit managers and insurers aggressively negotiate the prices of medicines
However, patient access to medicines is critical. Higher cost-sharing for medicines compared to other health services and complicated coverage rules can present barriers to access for patients, leading to poorer outcomes and higher costs in other areas.
Learn more about access to health coverage and potential hurdles patients face at AccessBetterCoverage.org.
Read more about how our nation's competitive biopharmaceutical marketplace controls costs while encouraging the development of new treatments and cures here.