By Mark Lebwohl, MD, November 02, 2015
In my column from the June issue of Dermatology World, I discussed an increasingly disconcerting issue that is continuing to plague our practices and our patients: drug pricing. There is no question or doubt that prices for both branded and generic drugs are on the rise. From doxycycline, to desonide, to psoriasis biologics, we have seen huge price jumps. As a result, our patients cannot get access to necessary treatments.
Expectedly, this issue has yet to be remedied. Fortunately, however, the cost of drugs is bubbling to the surface as a high priority among policymakers and constituents. On the 2016 presidential campaign trail, candidates are talking about it. On Capitol Hill, members of Congress are discussing ideas on how to bring prices down. Even the states are instituting caps on out-of-pocket costs for patients. However, every day we as physicians see the effects of this problem directly. I can testify that the situation for psoriasis patients is becoming increasingly dire. We have great medications and treating psoriasis today is so much easier than it was 20 years ago. However, 80 percent of patients with severe psoriasis are being treated with nothing or with creams alone. And that is a shame. We cannot sit on the sidelines and just hope that our policymakers will figure it out. When I wrote about this topic in June, I pledged to work on the issue. Now, I can confidently say that the Academy has a multi-faceted plan in place to tackle it.
From the congressional perspective, the Academy has been working with the Coalition for Accessible Treatments to advocate for the enactment of the Patients’ Access to Treatments Act (PATA) that would limit cost-sharing requirements for specialty drugs. Tiered cost sharing is how insurers claim patients have access to medications. However, if a drug costs $58,000 and the patient is responsible for 50 percent, how is that considered affordable? This bill would limit that cost-sharing scheme for drugs listed in a “specialty tier” classification to the co-pay amount listed for drugs in a lower, non-preferred brand tier.
At the more local level, the Academy is working closely with patient groups, providers, and industry groups. Several AAD members will participate in a program funded by Pfizer to distribute $1.5 million to state societies so they can educate patients and physicians about the difficulties of accessing therapies. Additionally, through the State Access to Innovative Medicines (SAIM) Coalition, the Academy is working to pursue state legislation that would limit prescription drug out-of-pocket costs and thwart insurers’ step-therapy policies that require patients to fail a cheaper drug before being granted approval to utilize a more expensive, and sometimes more effective drug. So far, the Academy has helped draft the model step therapy legislation that was introduced in eight states this year.
Finally, the Academy’s Regulatory Policy Committee has convened a Task Force on Drug Pricing and Transparency. This group will seek to increase drug-pricing transparency and help patients access the treatments they need. In the short term, the task force will develop a comprehensive position statement on patient access to prescription drugs, and create a state society tool kit that will contain sample resolutions on drug pricing and transparency, talking points, and background materials to support state efforts on step therapy.
These are just a few ways in which the Academy is working for you and your patients on this critical issue. However, the Academy is only effective when its members are vocal. In order to make progress on this issue, it will require a great deal of physician partnership and collaboration with other players in the health care system. Please write to your members of Congress and support PATA. Call your state representatives and tell them why step-therapy legislation and prescription drug cost limits are important. As a specialty, let’s be at the forefront of the discussion, and lead the charge on this issue, because your patients need your help — beyond the examining room.