Wrapping up HHS’s Pharmaceutical Forum: Putting Patients First and Finding a Path Forward

By Andy Slavitt, CMS Acting Administrator @aslavitt

On Friday, November 20th, Secretary Burwell and I welcomed patients, advocates, pharmaceutical manufacturers, providers, payers to discuss ways we can work together to achieve our shared goals of fostering innovation and improving accessibility and affordability of life-changing medicines. Nearly 1,500 people participated in person and online discussing the important issues of how to continue to drive innovation while expanding access to drugs now and into the future for individuals, particularly those on fixed- and low-incomes. While there were various perspectives represented, I was pleased that the tenor of the dialogue was to focus on the long-term national interest. Those with whom I spoke after the forum told me they learned something and felt that a diversity of views were fairly represented. Many of those people also said that the government should move in this area in a thoughtful, yet urgent way.

Patients First

We convened the forum to gather broad input on how to make sure patients can afford needed medications and how the health care system appropriately pays for these innovations. Importantly, across all viewpoints, I heard common ground of putting patients first and improving the value we receive from our health care system. Ken Frazier, Chairman & CEO, Merck explained, “We share the administration’s goals of creating a more affordable and sustainable health care system, promoting innovation, and access to new medicines.”

Susan Denzter, the forum’s moderator, summarized the day’s discussions http://thehealthcareblog.com/blog/2015/12/09/tackling-rising-pharmaceutical-prices-50-shades-of-gray/. Susan’s report provides a great summary. As I review these highlights, several important insights emerge.

  • Many spoke about how patients are desperate for new cures and new therapies, no matter the cost, which supports the need for continued incentives for development and innovation. There was caution not to oversimplify the problem or to forget the great value of life-saving therapies. Mark Boutin, CEO of National Health Council, affirmed this point by stating, “We cannot simply address the cost of one item without looking at the entire healthcare ecosystem. Medicines are a huge part of the ecosystem. But we have to look at the entire solution.”
  • Consumers and large purchasers articulated serious access and affordability concerns regarding their ability to afford continued large-scale increases in new drug costs, no matter their relative benefits. Lisa Gill, the Editor of Consumer Reports Best Buy Drugs, said, “If people cannot afford their medications, they may do pretty dangerous things. They may skip dosages, they may split pills, skip doctor visits, procedures or tests. All of these things lead to worse health outcomes.” And Bernard Tyson, Chairman and CEO of Kaiser Permanente added, “The current trend of rising drug prices is unsustainable and a threat to health care affordability and accessibility.”
  • There is a widespread assessment that the status quo isn’t working and that are a number of opportunities for improvement – ranging from looking at underlying drug development costs, to improving drug adherence, to better aligning incentives. The government was challenged to help improve the innovation timeline and approval process. Panelists and members of the audience discussed how best to define value for pharmaceuticals and considered how value-based purchasing concepts — both familiar concepts for medical services — can be applied to purchasing medications. We heard about the promise of these concepts but also the need for more experience with them to prove their worth. As Steve Miller of Express Scripts summed up, “We’re going to have to try a tremendous number of experiments, and it’s going to take cooperation with everyone in this room if we’re going to be successful.”

Better Information

Improving the accessibility of information about significant drugs, including information on their costs, value, and prescribing patterns also received a lot of attention across a number of panels. The question of how to judge the cost and value of new and existing therapies was linked to improving understanding on the relationship between medical and pharmaceutical spending. Some common questions emerged as important to strive to answer:

  • How should we measure drug costs not in a vacuum, but in the context of a patient’s outcome and overall care, including the potential reduction in other costs resulting from drug therapy?
  • Which drugs are increasing in cost and what is driving those increases?
  • How can we dissect the elements of drug prices so we can better understand the relationship between retail price and the final price paid by the consumer or purchaser?
  • What hidden costs increase the prices of a drug, and what incentives affect the prescriber’s choice of a drug?

No one has all the information to address these and other questions. Progress can only occur with collaboration among stakeholders, including increased access to data from many sources. There are business practices that keep much of this information hidden. Improvement in understanding our central question will only come if industry commits to releasing information. For a number of years, CMS has been dedicated to transparency, releasing hundreds of public use files and millions of lines of data each year on costs, chronic disease, utilization, and quality across a number of health care services. One important principle is that if taxpayers are paying the bill, the information on what we pay for should be in the public domain and made available to consumers, researchers, innovators, and care providers.

Further Steps

Taken together, the forum made me hopeful that we can find common ground in promoting innovation and improving access and affordability. I look forward to continuing this valuable dialogue and commit to you that we will do our part to improve the information available. We at CMS will also continue to solicit stakeholder input as we consider additional steps that are in the interest of those we represent in the Medicare, Medicaid, CHIP, and Marketplace programs, and the health care system as a whole. The American public is counting on our leadership and I am confident that by working with our partners, we will find solutions that support continued pharmaceutical breakthroughs, and access to those breakthroughs leading to healthier people.

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