World Health Day: How Do We Afford the New Era of Medicine?

For World Health Day, the World Health Organization reminds us that “everyone, everywhere should be able to access essential, quality health services without facing financial hardship.”

This is particularly true in light of today’s progress to finding innovative treatments for chronic and acute diseases. New medicines are transforming care for patients fighting cancer, hepatitis C, high cholesterol and more. We are in a new era of medicine, and the advancements made by biopharmaceutical researchers can be seen in a number of areas:

• Deaths from heart disease have dropped from 412,000 in 1980 to 168,000 in 2015, and in 2013, after being the third or fourth leading cause of death for 75 years, stroke moved to the fifth spot.
• In the United States, 16 diseases are now preventable as a result of childhood vaccines resulting in an estimated $1.4 trillion in societal costs saved.
• In 1981, life expectancy for a patient with HIV/AIDS was measured in weeks and months. Today, a 20-year-old with HIV could now live to age 78—the same life expectancy for the general U.S. population.

Unfortunately, despite these incredible achievements, many patients today are facing rising out-of-pocket costs and eroding coverage for prescription medicines. While medicine spending is growing at the slowest rate in years, changes in insurance benefits over the last decade have resulted in far higher costs for some of the sickest patients.

For example, in recent years, pharmacy benefit managers (PBMs) and insurers have been increasingly shifting more health care costs to patients. According to data from the Kaiser Family Foundation, since 2006, deductibles have increased 300 percent and there has been an 89 percent rise in what patients pay in coinsurance, which is a percentage of costs associated with their health care service or medicine.

Unlike care received at an in-network hospital or physician’s office, negotiated discounts for medicines are not shared with patients with high deductibles or coinsurance. As a result, a patient in a high-deductible health plan may end up paying hundreds—or even thousands—more annually than their insurer.

That’s why biopharmaceutical companies are working with insurers to develop innovative and flexible ways to pay for medicines that focus on results, lower out-of-pocket costs and enable patients to access the right treatments the first time. We are also working to ensure patients have access to medicines by sponsoring the Partnership for Prescription Assistance (PPA), among other efforts. This collaboration of PhRMA’s member companies has helped connect more than 10 million people to patient assistance programs that may offer prescription medicines for free or nearly free. We can afford the new era of medicine, and we can make it easier for patients to access these innovations too. To learn more about what America’s biopharmaceutical companies are doing to help lower costs for patients, visit letstalkaboutcost.org.