It’s a costly time for hospitals. In the report, “Trends in Hospital Inpatient Drug Costs: Issues and Challenges,” the National Opinion Research Center found that inpatient drug costs per admission are skyrocketing, having increased 38.7 percent in the three-year period from 2014 to 2016. These increases are due to higher demand for prescription drugs and the growth in drug unit prices.

Pharmaceutical industry observers have been riveted by recent reform proposals introduced by the Trump administration to regulate drug rebates—the backend price concessions that drug manufacturers pay to plan sponsors and PBMs to influence formulary position and market share. In the meantime, important and yet less noticed reforms are advancing at the state level that relate to copay coupons—the front-end price concessions that manufacturers furnish to patients to reduce out-of-pocket costs on drug purchases. 

Unchecked rising drug costs have made the opaque pricing practices of PBMs and drug manufacturers a popular target for greater regulation, and for good reason. Traditional PBMs and Big Pharma realize tremendous profits while employers and consumers have shouldered the burden.

Jake Frenz

Jake Frenz

A few years ago, if you had mentioned ICER, even pharma industry insiders wouldn’t know what you were talking about—or would have confused it with confirmation of naval orders (aye, sir!). Now ICER—the acronym for the Institute for Clinical and Economic Review—has become familiar to anyone involved in the business side of the pharmaceutical industry and a major force in payer–manufacturer price negotiations.

Nathan White

Kenneth Frazier, Merck’s CEO, is not a newcomer to social justice. That is probably why he was ready to speak out first after Charlottesville and resign from the President’s American Manufacturing Council while Jeff Immelt, the CEO of General Electric and others stayed quiet, perhaps afraid of the consequences of a POTUS Twitter storm.

When House Speaker Paul Ryan describes what he thinks should replace the Affordable Care Act, he says health care needs to be more patient centered. He is not espousing the long-held view among clinical professionals that patient-centered care ensures that patient preferences and values guide clinical decision-making à la the Institute of Medicine’s (IOM) definition. Instead, Ryan defines patient-centered health care as a set of policy changes that will result in lower costs, more insurance coverage options, and greater control over where someone can receive health care.

In an era of rapidly escalating prices, the 340B drug discount program remains one of the few checks to keep medicine and medical care accessible to the underserved. Contrary to the recent column, "Payers Must Develop Strategies To Overcome 340B Hurdles," it is not being exploited by participating hospitals. If it were, where exactly is the money?

 A few days ago, I went to the “Poke-stop” in my small town of Waconia, Minnesota, (population 11,490) to learn why I was losing my Pokémon “gym battles” and, more importantly, to survey the growing numbers of twentysomethings exploring my community’s parks and landmarks. I met a group of 15 Waconians for the first time, and they were excited about describing how Pokémon Go had increased their activity levels, their awareness of our community’s history, and their engagement with others.

Our country is in crisis. We have an epidemic on our hands that crosses geographic boundaries, socio-economic status, gender, and many other categories. According to the American Society of Addiction Medicine, drug overdoses kill nearly 50,000 Americans each year. The media is certainly putting a microscope on it. Legislators are acting on it. Every stakeholder in the medical delivery chain is analyzing it–and I encourage physicians and other prescribers to take a look at their role in the problem.

Paper or plastic? Debit or credit? Netflix or Amazon? These are the kind of choices we are asked to make everyday. They are not, though, the type of decisions that keep us up at night.

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Legislation and regulation
By Richard Mark Kirkner
Legislation and regulation
By Richard Mark Kirkner