Going forward, Hernandez said she wants to concentrate on figuring out to what extent net prices are changing compared to list prices. “Every time we present findings, we get heavy criticism because most of our research is related to list prices, but that’s the data we have,” she said. “We want to look at net pricing data. In what markets is competition happening? In what markets do list prices translate into net price increases? We need to provide transparency about what we’re paying for drugs. The current system relies heavily on rebates, but it’s hard to fix the drug pricing problem without trying to increase transparency.”
Elsewhere, research by pharmacy school faculty is focused on the value that medication brings. Goldman believes more attention should be devoted to the reimbursement side. “This move toward personalized medicine means we need to integrate economics with pharmacogenomics and epidemiology to understand who benefits from what treatment,” he said. “Pharmacy schools need to take a leadership role in saying we’re spending too much and in some cases we’re spending too little. We are undertreating some things and overtreating others.”
He sees schools starting to focus on outcomes research, which is an important part of how products are covered, priced and reimbursed globally. “It’s exciting to me that we’re starting to see these changes in the United States,” he noted. “Pharmacy schools can start to be part of the solution in figuring out which drugs to cover and who benefits. We can move away from the traditional formulary design to ensuring that patients have better outcomes.”
Pharmacists on the Front Lines
Discussions around drug pricing include taking a hard look at Medicare, which is expected to account for 18 percent of federal spending by 2028, according to the Schaeffer Center. There is a particular sense of urgency about addressing Medicare Part D, the Medicare prescription drug benefit. A proposed plan to end kickbacks in the pharmacy distribution chain would lower the list prices of drugs in the Medicare Part D system. PBMs argue that eliminating rebates could result in higher costs for seniors who have Part D insurance. But earlier this year, Goldman and his colleague Dr. Erin Trish estimated that beneficiaries would be responsible for only a small portion of the increase (an average of $4.31 per month, which is in line with the estimate from HHS) and most would be insulated from the costs.
“The Affordable Care Act was a success in starting to close the donut hole, but with the program as a whole there was a lot of concern about making sure that plans would participate,” Goldman explained. “We set it up with the government providing reinsurance. In some ways you can think of it as a policy program on training wheels. It’s time to take the training wheels off. There are a lot of plans playing in the space and we need to update the features they are offering. We’ve created some perverse incentives rather than have the plans truly compete. We need to revisit it.”
As the election approaches and healthcare spending continues to be in the spotlight, Goldman urges pharmacists to emphasize their crucial role in controlling costs. “Pharmacists have access to some of the most effective tools for managing chronic illness,” he said. “The key to saving money is keeping people out of the hospital. That puts pharmacists on the front lines. They play a role in making sure patients are adherent and are on the best regimens for their condition. They are part of the solution to the high cost of treating chronic illness.”
Hernandez said there has been a lot of talk without much action when it comes to controlling costs, but she is optimistic that change is coming. “I’m hopeful we’re in the best environment for something to happen on drug prices,” she said. “Around 80 percent of the public agrees that drug prices are too high. Both political parties recognize that this is a problem that needs to be addressed. With the Senate investigation on insulin prices, we have been talking to senators and it’s interesting to see people on both sides of the aisle want to work together. So I think we’re in the greatest time to get some regulation around this.”
Jane E. Rooney is managing editor of Academic Pharmacy Now.