Studies, CMS look at lowering prescription prices
Even as Medicare seeks to negotiate down the costs of 10 prescription drugs, researchers are examining the effectiveness of existing private programs to provide lower drug costs and copays.
Two recent studies and government action focused on prescription drug costs.
On Aug. 29, CMS announced it will negotiate prices for 10 drugs covered under Medicare Part D.
The drugs are Eliquis (apixaban), Jardiance (empagliflozin), Xarelto (rivaroxaban), Januvia (sitagliptin), Farxiga (dapagliflozin), Entresto (sacubitril/valsartan), Enbrel (etanercept), Imbruvica (ibrutinib), Stelara (ustekinumab), and Fiasb and Novolog (both insulin aspart). Companies who choose to enter the negotiation will do so by Oct. 1, with the maximum fair prices announced Sept. 1, 2024, for rollout in 2026, according to an HHS press release.
The announcement coincided with the release of two unrelated studies that appeared Sept. 5 in Annals of Internal Medicine, the first of which found that at least one out of five prescriptions for commonly prescribed generic medications were cheaper through discount cards than through out-of-pocket (OOP) payments made by patients.
Researchers compared OOP payments obtained from 2020 Medical Expenditure Panel Survey (MEPS) to 2023 discount card pricing (Amazon Prime and GoodRx Gold) for 20 commonly prescribed generic medications. They estimated OOP payments exceeded Amazon and GoodRx discount card pricing benchmarks for about 20% and 43% of prescriptions evaluated, respectively. The proportion of excess OOP payment assumed to be in the no-coverage (deductible) phase was 40% and 79%, respectively. Estimated cumulative OOP cost savings assuming patients obtained their medications using Amazon and GoodRx discount cards amounted to approximately $969 million and $1.83 billion, respectively.
The authors cautioned that the discount cards are not an effective solution to prescription drug costs. They wrote, “Although some discount card programs may provide temporary relief for patients' OOP costs on select generic medications, their dependence on pharmacy benefit managers for claims adjudication and access to contracted pharmacies hinders long-term solutions. To reduce OOP costs effectively, policy reforms facilitating the adoption of value-based insurance designs are necessary.”
A second study found that among 19 low-cost generic programs, medication coverage for six cardiovascular diseases (CVDs) varied significantly, with the Mark Cuban Cost Plus Drug Company demonstrating the most comprehensive coverage for all diseases.
Researchers evaluated the proportion of programs that offered evidence-based medicines for atrial fibrillation, heart failure, hyperlipidemia, hypertension, post-acute coronary syndrome secondary prevention, and stable angina. The authors found that the availability of CVD medication varied by program, drug, and condition. Low-cost generic programs affiliated with H-E-B, Kroger, Walmart, and Mark Cuban Cost Plus Drug Company had the most breadth and choice of coverage, the study found. Almost all programs offered angiotensin-converting enzyme inhibitors, beta-blockers, thiazides, and moderate-intensity statins, but availability of higher-cost or less frequently used generics was lower. The authors suggested that such programs should identify existing limitations in their coverage and continuously revise their formularies to improve the comprehensiveness of CVD medication coverage.