Common-sense reforms can help ensure everyone benefits from America’s engine of innovation and receives the care they need and deserve. In this series, we’re taking a closer look at PhRMA’s advocacy efforts to make medicines more affordable, part of our patient-centered agenda which aims to lower barriers between our industry’s medical innovations and patients who need them.
With research showing 30% of Americans that have insurance still face a financial barrier to care like having out-of-pocket costs that are more than they can afford, it’s clear we need patient-centered reforms that can help improve health care affordability.
The list prices of brand medicines are reduced by 40%, on average, by rebates and discounts that pharmaceutical companies pay to health insurance companies, middlemen like pharmacy benefit managers (PBMs), the government and others. But in many cases, these rebates and discounts are not used to directly lower out-of-pocket costs for patients taking those medicines.
This issue occurs in both Medicare Part D and in the commercial market, where patients with deductibles and coinsurance often pay cost sharing based on the full list price of a medicine even though their insurer pays a lower net price. We must ensure these savings are passed on to patients at the pharmacy counter.
Insurance companies and PBMs say they use these rebates and discounts to lower monthly premiums, but that’s not how insurance should work: sick patients shouldn’t subsidize costs for the healthy. A majority (59%) of adults with insurance coverage agree, saying they would prefer paying lower out-of-pocket costs compared to paying lower premiums each month. Patients, especially those managing multiple conditions or with serious conditions like autoimmune and infectious diseases, are even more likely to support changes in health care coverage that lower out-of-pocket costs.
If insurance companies and middlemen don’t pay the full price for medicines, patients shouldn’t have to either.
Learn more about how we can improve patient affordability by visiting PhRMA.org/BetterWay.