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A report from the Alliance of Community Health Plans can help get a better sense of how well drugs help patients compared to other treatment options.
For patients needing medication to control their elevated low-density lipoprotein (LDL) or “bad” cholesterol, generic statins are a safe, affordable treatment, according to a report from the Alliance of Community Health Plans (ACHP).
An ACHP infographic highlights significant variation in drug costs for the one in three adults who have elevated levels of LDL cholesterol, depending on whether they take generic statins or a new class of drugs, PCSK9 inhibitors. Generic statins can cost as little as $40 per year, while PCSK9 inhibitors can cost more than 356 times that amount, or up to $14,308 yearly. This is the fourth in the series Spike in Drug Costs.
PCSK9 inhibitors are better suited for patients with familial hypercholesterolemia, fewer than 1% of the patients with high LDL, according to ACHP President and CEO Ceci Connolly.
“They are quite pricey-up to 356 patients can be treated with generic statins for the same cost as treating one patient with PCSK9s-and they have some undetermined health effects,” Connolly says.
“Rising drug costs are making it hard to ensure all Americans get the medications they need at an affordable cost,” Connolly says. “The goal is to get the right drug to the right patient at the right time for the right price.”
Drug prices-especially for common chronic conditions-are rising at an alarming rate, according to Connolly. “Prescription drug spending rose 12.6% in 2014 and is expected to rise 7.3% a year through 2018. That far exceeds inflation, which means pharmaceutical spending is crowding out other important expenditures. By 2020, specialty drugs will make up 50% of all medication costs nationally rising from $98 billion spent in 2016 to $212 billion in 2020. While ACHP members offer assistance with medication management to consumers-which can improve health and manage costs-these strategies are not enough on their own,” she says.
To keep premiums under control, health plans try to absorb many drug cost hikes, but that’s not a sustainable business model, according to Connolly. “Our nonprofit community plans are running out of ways to provide lifesaving treatments and maintain low premiums. Ultimately, we all need to better understand how much drugs cost manufacturers to produce, in order to get a handle on how they are priced,” she says.
Drug companies should be expected to share how much they spend on research and development compared to other costs such as marketing and advertising, according to Connolly.
“Many health plans already share similar information with their consumers-with cost estimates for, say, a specific treatment in a given facility,” she says. “And plans must file rate requests with regulators each year. The drug industry has a similar responsibility to its customers.
“Transparency can also help the healthcare industry get a better sense of how well drugs help patients compared to other treatment options,” she adds. “We need more clarity about both the cost and relative effectiveness of drugs, so we can all work together to ensure consumers can access the drugs and treatments they need at an affordable cost.”