Prescription drugs: The Bermuda Triangle of health care costs

health-care-costs

Lest you forgot about it for five minutes, allow us to remind you: it’s an election year. Both the Senate and the White House are on the block, and in this broiling climate of political opinion, it’s hard to name any issue that’s notpolarizing. Still, one issue remains paramount in the electoral machinations, and that’s health care. This isn’t about the future of the Affordable Care Act, by the way. While the ACA remains a perennial point of contention (reform it? repeal it? retain it?), at this point Obamacare has been entirely overshadowed by something more urgent: the high cost of prescription drugs and how it is impacting health care cost containment.

Rising drug prices: America’s top health care concern

“Medicare spent $4.6 billion during the first half of 2015 on expensive drugs to treat hepatitis C, and new treatments for high cholesterol are so expensive that people are debating whether the value is worth the price,” said Anna Maria Barry-Jester at the polling aggregation website FiveThirtyEight. “Poll after poll shows that high drug prices are the leading health care concern in the United States.”

Whether it will continue to be a top concern for candidates is another question. As with any hot political issue, there’s money involved. “The politically powerful pharmaceutical industry will fill the campaign coffers of both political parties as drugmakers press their own agenda, which includes stopping any price regulation or Medicare negotiations on prices,” said Modern Health care contributors Harris Meyer and Shannon Muchmore.

Drugmakers have already won bipartisan support for lighter regulatory review on new drugs and medical devices. On costs, it’s unclear how their influence may sway the candidates that be. It’s also unclear why drug prices ballooned in the first place. There is no single reason, but when Elsevier surveyed stakeholders (including health plans, PBMs, retail pharmacies, drug wholesalers, manufacturers and health care providers), over 75 percent thought that manufacturer consolidation was the first or second most likely reason.

What does this mean for the health care industry?

Ninety-one percent of stakeholders in the Elsevier survey said their business has been affected by rising drug prices. For 62 percent, those impacts were negative. For example:

  • Below cost pharmacy reimbursements due to low MAC prices
  • Difficulty sourcing alternative medications to fit patients’ budgets
  • Medication non-adherence due to costs
  • Inaccurate price forecasts
  • Increased government scrutiny

With prices continuously fluctuating, stakeholders must keep fingers on the pulse at all times. Forty percent of respondents said they monitor prices daily. To make things more difficult, the data they’re monitoring isn’t always current or accurate.

Until candidates’ political positions on high drug prices become clearer later in the year, health care stakeholders must brace themselves to steer in the dark. Tom Miller of the American Enterprise Institute put it this way: “We’ve moved into the Bermuda Triangle and the instruments don’t seem to be working properly.”

To put it another way, the only answer for now is, “Constant vigilance!” On that, we can help. Subscribe to our blog for health care updates, and stay vigilant throughout 2016 in the quest for health care cost containment.

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