In case you missed it, a forthcoming study will disprove – once again – misleading claims pharmacy benefit managers and insurers, among others, routinely make about spending on new innovative medicines.
The Partnership for Health Analytics Research (PHAR) conducted an analysis of predictions of health care costs made prior to the introduction of 14 new medicines and found they were often dramatically overestimated.
In the case of new cholesterol-lowering medicines, called PCSK9 inhibitors, the Institute for Clinical and Economic Review predicted the one-year cost of the two PCSK9 inhibitors would be $7.2 billion. In reality, based on reported sales, the actual cost will be approximately $83 million, an overestimate of $7.1 billion.
In addition to the two PCSK9 inhibitors, PHAR studied medicines to treat various forms of cancer, hepatitis C, obesity management, cystic fibrosis, heart failure, psoriasis and diabetes. On average, predictions were 11 times higher than actual sales. According to PHAR, for every $11 of predicted cost there was only $1 of actual cost to the health care system.
Overestimating drug costs may negatively impact patient access. Payers may be more likely to impose utilization management restrictions or require high cost-sharing for new medicines, making it difficult for patients to access clinically appropriate therapies. Higher cost-sharing for medicines compared to other health services and complicated coverage rules already present barriers to access for patients, leading to poorer outcomes and higher costs in other areas.
PHAR’s results were submitted for presentation at the Association of Managed Care Pharmacy’s upcoming NEXUS conference.
Learn more about how our nation’s competitive marketplace helps to control costs while encouraging the development of new treatments and cures at phrma.org/cost.
Read more about PhRMA’s policy solutions to deliver innovative treatments to patients here.