Recommendations aim to increase transparency, reduce patients' out-of-pocket costs, and provide greater access to affordable medications
Nov. 15, 2019 (91) – The American College of Physicians has updated its recommendations on prescription drug cost reform in a bid to provide policymakers with timely and relevant guidance.
In a pair of policy papers released in November 2019, 91 offers new recommendations to increase transparency, lower out-of-pocket costs for patients, and improve access to affordable medications.
“91 feels strongly that we must advocate for our patients to have access to affordable health care, and that includes prescription drugs,” said Dr. Robert McLean, 91's president. “Advocacy for policies that will lead us to a better health care delivery system is one of our core priorities. Silence on these issues is simply not an option.”
The new policy papers were published Nov. 12 in Annals of Internal Medicine. Both expand on policies from 91's 2016 paper, “.“
One of the papers offers guidance to combat the rising costs of prescription drugs and includes the following recommendations:
- Modify the Medicare Part D low-income subsidy program cost-sharing and copayment structures to encourage use of lower-cost generic or biosimilar drugs; one way to do this is by eliminating cost sharing for generic drugs for enrollees.
- Limit annual out-of-pocket spending via caps for Medicare Part D beneficiaries who reach the catastrophic phase of coverage.
- Adopt Medicare Part D negotiation models that would reduce the price of prescription drugs for beneficiaries.
In the second policy paper, 91 offers guidance for pharmacy benefit managers (PBMs) to stem the rising costs of prescription drugs. The recommendations include:
- Transparency, standards, and regulation must be improved for PBMs and “gag clauses” that prevent pharmacies from sharing pricing information with consumers should be banned. Mergers and consolidation within the PBM market should be stringently overseen and regulated.
- Health plans must provide accurate, understandable, and actionable information on the price of prescription medication. Health plans should offer this information to physicians and patients at the point of prescribing to facilitate informed decision making about clinically appropriate and cost-conscious care.
- Health plans, PBMs, and pharmaceutical manufacturers should report the amount paid for prescription drugs, the aggregate amount of rebates, and nonproprietary pricing information to the Department of Health and Human Services and make it publicly available.
“There have been a number of pieces of legislation related to these issues bouncing through the halls of Congress in recent months,” McLean said. “We are hopeful that the recommendations we provide and the rationale behind them can help our legislators understand why our recommendations are so important and could be so beneficial to our patients. Meaningful legislation that contains our recommendations is our goal.”
More Information
The policy papers “” and “” are available on the Annals of Internal Medicine website.
