- Physicians are harboring concerns that the Trump Administration’s recently-announced plans to revamp prescription drug pricing will harm patient care access, increase patient costs, and reduce overall care quality, according to a survey conducted by the Community Oncology Alliance (COA).
The Trump Administration recently announced a blueprint for reforming prescription drug prices with the end goal of reducing out-of-pocket costs for patients. The blueprint notably included calls for better price transparency from prescription drug manufacturers.
The COA survey specifically addressed proposed reforms to Medicare Part B and Part D, including calls to shift many Part B drugs to Part D. Additionally, COA surveyed about proposals to establish more pharmacy benefit managers (PBMs) that could serve as middlemen between pharmaceutical companies and providers. PBMs are in charge of price negotiations.
These proposals may have had good intentions, COA conceded. Few medical industry professionals want to see drug prices increase for patients, but the current approach may have unintended consequences for cancer patients, said COA president Jeffrey Vacirca, MD, FACP.
“Cancer patients have endured decades of health ‘reform’ and big ideas from Washington that have backfired, making it more difficult and much more expensive for them to receive care. Policymakers must be careful that patients do not have to suffer through more half-baked, poorly conceived changes,” noted Vacirca, who is also CEO of NY Cancer Specialists.
“We must carefully think about and evaluate the impact of changes to our complex health care system and discuss them with patients and practicing physicians,” he continued. “If we are not careful, Washington could set the cancer care system back significantly, harming patients, and increasing costs.”
But providers are largely wary of the impacts of these program changes, the survey of 100 oncologists or hematologists and 50 rheumatologists revealed.
Specifically, providers have concerns about reforms to the Medicare Part B and Part D programs and how those changes would impact prescription drug affordability. Eighty-five percent of patients said shifting drugs from Medicare Part B to Part D would adversely impact drug affordability and patient access to care.
Eighty-nine percent of providers said those affordability issues could delay patient treatment access, while 92 percent said they think potential cost increases could reduce the number of treatment choices patients have.
Ninety-three percent of providers said the shift in Part B and Part D drug costs would increase administrative burden.
Additionally, providers have their reservations about the impact that a Competitive Acquisition Program (CAP) or Drug Value Program (DVP) would have on patient care, the survey revealed. Eighty-eight percent of surveyed clinicians said CAP and DVP programs would take drug and treatment decisions away from “the person in the best position to make that decision.”
Over 87 percent of respondents said CAP and DVP models would hinder provider ability to deliver quality care to patients. Seventy-five percent of respondents said the programs would increase administrative burden, and 61 percent said they would diminish providers’ prescribing autonomy.
None of this is to say that providers disagree with the Administration’s goals to reduce out-of-pocket spending for prescription drugs. Patients currently play an extraordinary amount for their medicine, and reforms are needed to solve that problem. This is especially true in cancer care, where patients face a litany of medications at extraordinary costs, COA representatives said.
To cut prescription drug costs, especially for cancer patients, COA recommended CMS reduce the role of middlemen in drug pricing, not increase it as current proposals suggest.
“Faulty government policy on Medicare Part B has resulted in massive consolidation of our nation’s cancer care delivery system as documented by cancer clinic closings and care moving into the much more expensive hospital setting,” said COA executive director Ted Okon. “The result has been access problems and higher costs for Americans with cancer, especially seniors. And it’s no surprise that health care spending has steadily increased with this consolidation.”
According to Okon, current proposals will hinder the negotiation process for drug costs.
“I am shocked that this Administration is going to throw fuel on this fire by moving Part B drugs into Part D and by bringing more middlemen in to so-called ‘negotiate’ drug prices,” Okon added. “History clearly shows that this will result in cancer patients having more difficulty getting treatment and paying more for it, including higher drug list prices. This will put the nation’s cancer care delivery system in even greater peril.”
For example, these “middlemen,” who could eventually be in charge of drug price negotiations, often profit from delaying patient access to the drug, COA explained. This has an adverse impact on a patient’s treatment trajectory.
“COA and community oncology practices are actively working on solutions to high drug prices and the cost of cancer care by relying on the real-world medical experiences of providers on the front lines of cancer care to craft viable, truly patient-centric solutions,” the group concluded. “This includes providing practices with the support that they need to succeed in the Centers for Medicare & Medicaid Innovation Oncology Care Model (OCM), as well as by developing the OCM 2.0, a universal model of oncology payment reform that includes value-based payments for drugs and services.”
Other industry groups have taken a critical view of the drug pricing blueprint, including the Pharmaceutical Research and Manufacturers of America (PhRMA). In a statement released following the blueprint’s release, the agency said the Administration’s proposals could have unintended consequences on patient treatment access.
“These far-reaching proposals could fundamentally change how patients access medicines and realign incentives across the entire prescription drug supply chain,” said PhRMA president and CEO Stephen J. Ubl. “While some of these proposals could help make medicines more affordable for patients, others would disrupt coverage and limit patients’ access to innovative treatments.”