AHIP, AMA weigh in on administration's blueprint to lower drug prices

AHIP office - Credit: Google Street View

The Department of Health and Human Services released what it called a "blueprint" for lowering the cost of prescription drugs -- a series of legislative and regulatory proposals for which HHS sent out a Request for Information to various healthcare organizations in May. And this week America's Health Insurance Plans and the American Medical Association have weighed in, both agreeing with certain proposals and taking issue with others.

In a letter to HHS Secretary Alex Azar, AHIP expressed its support for several legislative and regulatory steps it believes have potential for providing consumers relief from high prescription drug costs. At the top of the list is promoting generic competition, with the organization contending that HHS should prevent brand-name drug manufacturers from using risk evaluation and mitigation strategies to block competition from generic drugmakers.

AHIP also supported the proposal to create a competitive market for biosimilars, saying the widespread adoption of biosimilars would offer affordable alternatives to expensive, branded biologics. The group also backed efforts to allow Medicare Part D plans to address price increases for a sole-source generic through changes to their formulary or benefit design; and to enhance transparency through the release of the enhances CMS Drug Pricing Dashboards for Medicare Part B and D, as well as Medicaid.

Despite that approval, AHIP also expressed concerns with several ideas and proposals in the blueprint. "The RFI appears to suggest that health insurance providers may instead favor drugs with high list prices and high rebates at the expense of lower costs," according to the letter. "Simply, health insurers have no such interest in higher prices."

Further, the group contended the notion that incentives alone will produce cost reductions. "Instead," the letter states, "plans obtain deep discounts in exchange for preferred formulary placement and lower patient cost-sharing that result in greater market share for drugmakers' products, but only if plans can leverage competition between manufacturers."

In its own letter to Azar, the AMA said manufacturers and insurers are placing cures and treatments out of the reach of patients, and said the policy solution should result in lower cost prescription drugs; increased transparency; more competition and production capacity in all segments of the pharmaceutical and biologic markets; and decrease administrative and red tape burdens. 

AMA also said the solution should not be to shift costs from one set of patients to another through higher across-the-board premiums.

"The AMA does not support Blueprint proposals that increase patient costs and erect barriers, including onerous insurer paperwork requirements that impede timely patient access to affordable and medically necessary medications and treatments," it said in its letter. "Further, the AMA opposes policies that would financially penalize physicians and pharmacists for high cost prescription medication."

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Email the writer: jeff.lagasse@himssmedia.com