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The Spike in Drug Prices: Infographic Series
ACHP’s infographic series highlights drug cost trends for widely prescribed drugs within various therapeutic classes and communicates the potential effect of these prices on key stakeholders.
» Generics (released in June 2017).Transparency in drug pricing can help increase competition in the marketplace and help consumers make better choices about their health care. Yet, consumers often lack the information they need. Key takeaways include:
- While generic drugs generally provide a low cost alternative to brand name drugs, a lack of competition in the generic market is arbitrarily increasing prices, making generics as costly as brand drugs.
- The generic drug market is seeing some of the same pricing tactics as is the branded drug market. For example, after a branded drug increased its prices to $300 (nearly a 600% increase) in 2016, one of the generic versions followed suit with a 425% price increase to $225.
- Choosing one generic over another can save a lot of money, but that information isn’t always available.
- Doctors, purchasers, manufacturers and intermediaries need to work together to improve access to and affordability of prescription drugs.
» LDL Cholesterol (released in September 2016). Key takeaways include:
- Generic statins cost as little as $3.30 per month, are proven safe and generally well tolerated.
- Generic statins can both lower LDL cholesterol and reduce the number of heart attacks and strokes by 20 percent.
- PCSK9 inhibitors cost between $1,139 and $1,176 per month – and are best suited for people with familial hypercholesterolemia, or, fewer than 1 percent of patients with high LDL.
- PCSK9 inhibitors have undetermined effects on cardiovascular morbidity and mortality.
» Rheumatoid Arthritis (RA) (released in March 2016). Key takeaways include:
- The annual cost of treating RA in the U.S. is expected to increase by almost 50 percent from 2013 to 2020, and is expected to reach over $9 billion.
- The RA drug Enbrel now costs more than $4,000 for a 30-day supply, an 80 percent increase since 2013.
- The cost of RA drugs can exceed more than $1 million over the course of a lifetime.
- Sixty percent of people with inadequately treated RA are unable to work 10 years after onset.
» Multiple Sclerosis (MS) (released in December 2015). Key takeaways include:
- New MS drugs are launching at costs that are as much as 25-60 percent higher than the price of existing drugs.
- The cost of “first-generation” MS drugs already available to consumers can now top $60,000 per year, up from $8,000-$11,000 when they were first released.
- The MS drug Lemtrada, approved in 2014, costs $158,000 for a two-year course of treatment.
- The price of the MS drug Avonex has skyrocketed 537 percent since 2001, and now costs nearly $5,300 for a 30-day supply.
» Diabetes (released in August 2015). Key takeaways include:
- For six popular, brand-name diabetes drugs, costs rose over 150 percent apiece in the last five years, with two drugs seeing increases of over 250 percent.
- Primarily because of escalating drug costs, spending on insulin and other diabetes medications is expected to rise 18.3 percent over the next three years, a rate of increase 60 times greater than the recent income growth average of just 0.3 percent across all households.
- In 2012, the national cost of treating diabetes was a staggering $245 billion.
ACHP has created a slide deck for public use featuring some of the graphics and statistics in our infographic series. Access the slide deck here.
**ACHP members also have access to our drug cost toolkit, which includes an infographic user guide, key messages and more.**
Patient Insights: Helping Members Manage Their Medications
Medication Therapy Management (MTM) promotes collaboration among pharmacists, patients and providers to establish safe and effective drug regimens for optimal therapeutic outcomes. In addition to improved health outcomes, MTM provides significant cost savings for both members and health plans through the identification of more cost-effective drug alternatives, as well as decreased expenditures from avoided hospitalizations. Members of the Alliance of Community Health Plans (ACHP) have innovative MTM models that capitalize on the immense benefits such programs provide.
One example is Capital District Physicians’ Health Plan (CDPHP), which has a unique MTM program that identified 5,017 eligible members and conducted 1,151 comprehensive medication reviews in 2014 alone. Read more to learn the story of Gertrude, a CDPHP member who saw a total annual copay savings of $1,680 after engaging in MTM services.
Live Interviews on High-Cost Drugs
» On October 16, 2015, ACHP facilitated an interactive conversation about high-cost drugs with two health plan CEOs: John Bennett, M.D., from Capital District Physicians’ Health Plan in Albany, New York, and Patricia Richards from SelectHealth in Salt Lake City, Utah. The Robert Wood Johnson Foundation’s Susan Dentzer moderated the discussion, which included an interactive Q&A. Additional details are available in the slide presentation and webinar recording.
» On June 15, 2015, ACHP facilitated a live interview about high-cost drugs and the effect of these high prices on patients, insurers, providers and state and federal governments. The discussion focused on drug pricing trends; how new drugs are helping patients; strategies for ensuring patients have access to appropriate drugs; and emerging specialty drugs, such as the PCSK9 inhibitors for control of high cholesterol. Additional information is available in our event summary and blog post. A recording of the event is available online, as are the slides from the presentation.
Specialty Drug Cost Report
On October 7, 2014, ACHP held a briefing on Capitol Hill to provide insights into how the costs and pricing of specialty pharmaceuticals are affecting care and costs across the country. More than 70 individuals from the Hill and health care organizations joined us in a standing room-only presentation. The panelists offered data and concrete examples of the challenges that specialty drug costs pose to health plans, employers and others, and called for thoughtful collaboration across stakeholders to address access and affordability and shape durable policy solutions.
Read a full summary of the ACHP briefing on Capitol Hill.
In conjunction with the briefing, ACHP published Dollars and Sense: Putting Specialty Drug Costs in Perspective, an educational resource for stakeholders.
Curbing Prescription Drug Abuse
ACHP, along with nine other national organizations, sent two letters in May 2015 to Congressional leadership supporting provisions in the 21st Century Cures Act authorizing Medicare plans to implement programs to prevent prescription drug abuse under Medicare Parts C and D by establishing drug-management programs that require patients at risk of drug abuse to utilize designated pharmacies and prescribers to obtain controlled substances at risk for abuse.
21st Century Cures PRR Stakeholder Comments
PRR Principles Multigroup Support Letter
In August, 2015, ACHP signed a letter in support of S. 1913, Stopping Medication Abuse and Protecting Seniors Act of 2015.
In 2012, ACHP published a report titled Ensuring Safe and Appropriate Prescription Painkiller Use: The Important Role of Community Health Plans. This paper demonstrates how health plan initiatives address opioid misuse while ensuring safe and appropriate access to medications for patients with pain.
Specialty Pharmaceuticals: Ensuring Access and Affordability Through Coordinated Approaches – This white paper from Independent Health explains the current lucrative market of specialty drugs, the burden on consumers and potential solutions to help lower costs.
Q&A: Health plan executives discuss high drug prices (Managed Healthcare Executive, October 2015) – Featuring John Bennett, MD, of Capital District Physicians’ Health Plan, and Patricia Richards of SelectHealth
Health plan CEOs: Prescription drugs post major cost concerns (FierceHealthPayer, October 2015) – Featuring John Bennett, MD, of Capital District Physicians’ Health Plan, and Patricia Richards of SelectHealth
The True Culprits Behind Rising Generic Drug Costs (April 2015) – Blog post from Capital District Physicians’ Health Plan President and CEO John D. Bennett, M.D.
Drug Costs, with Dr. Bennett (April 2015) – Podcast from Capital District Physicians’ Health Plan President and CEO John D. Bennett, M.D.
Q&A: Dr. John Bennett on drug pricing and other threats to health care (Albany Business Review, February 2015) – Q&A with Capital District Physicians’ Health Plan President and CEO John D. Bennett, M.D.
Reform Update: Generic drugs’ high prices spur fears of failed drug adherence (Modern Healthcare, October 2014) – HealthPartners, Group Health Cooperative of South Central Wisconsin and Independent Health discuss health plan strategies to address the rising cost of generic drugs.
ACHP Pharmacy Fly-In Leave Behind (October 2015) – Conveys the dramatic increase in pharmacy drug costs over the past several years and the effect of this increase on ACHP members and other stakeholders.
Illustrative Statements from ACHP Member Plans (October 2015) – Statements and statistics from ACHP member plans on the increasing cost of prescription drugs and the corresponding effects.
Infographic: Diabetes Drug Costs Rising at Staggering Rate (August 2015) – Coverage of ACHP’s infographic on diabetes drug costs.
Study: Diabetes Drug Costs on Runaway Pace as Prices Soar up to 300 Percent, Study Finds (August 2015) – Coverage of ACHP’s infographic on diabetes drug costs.
A ‘Perverse” Marketplace for Prescription Drugs (The Huffinton Post, August 2015) – Authored by Harry Shamoon, M.D., associate dean, clinical and translational research, Albert Einstein College of Medicine.
Kaiser Health Tracking Poll: August 2015 – The August Kaiser Health Tracking Poll examines the public’s view on rising prescription drug costs.
PwC’s Medical Cost Trend: Behind the Numbers 2016 (June 2015) – Specialty drugs is one factor expected to boost the health care spending trajectory in 2016.
Kaiser Health Tracking Poll: June 2015 – June’s Kaiser Health Tracking Poll focuses on high-cost prescription drugs and the debate about who should pay for them.
“A Brief History of Drug Pricing” (May 2015) – Presentation by Tony Barrueta, Senior Vice President of Government Relations at Kaiser Permanente, at the Partnership for Quality Care.
ACHP Members: For more information on ACHP’s work related to prescription drugs, visit the Pharmacy Directors Collaborative webpage (login required).