The newest proposal to cut prescription drug costs could strip important protections for already vulnerable patients, especially those living in long-term care facilities.
Under the oft-repeated banner of making drugs more affordable, the proposal would relax coverage requirements for the six “protected classes.” Those include antidepressants, antipsychotics, immunosuppressants (transplant medications), anticonvulsants (seizure medications), antiretrovirals (HIV medications) and anti-neoplastics (cancer medications).
Consider this: Of all the possible solutions to higher prices, should the aim be to start with the medications of those with HIV, epilepsy, mental health issues, and with those who have survived a solid organ transplant?
Currently, Medicare must cover every medicine in each of the protected classes. The idea behind the administration’s proposal is that not requiring Medicare to cover every medicine strengthens payers’ negotiating power and reduces costs. Frontline clinicians, especially those treating vulnerable patients, would lose the ability to select proper medications and their careful consideration would become secondary to the payers’ cost focused schemes.
The concept to strip the protections isn’t new. It has been introduced by other administrations several times, including in 2014 and 2016. But it isn’t a good idea. It’s a distraction from steps that might actually address pricing issues.
Patients taking medications not covered by their insurer’s new formulary will face a difficult decision. They can switch medicines to what’s covered or pay hefty out-of-pocket costs to continue taking their current medicine. They may be forced to change plans to chase the medications that work for them (typically only an option once a year). For elderly patients taking multiple medicines a day and for those struggling with a very narrow window of success, changing even one medication isn’t as simple as it sounds. Pharmacists and physicians must consider risks of adverse effects and risks of failed therapy, in addition to standard concerns like drug interactions and adverse events. Patients may see disease symptoms re-emerge (an increase in seizures or depressive episodes), their treatment may fail (like rejection of their transplant or a violent psychotic issue) or they may experience side effects from the new medications that are not only bothersome but may lead to non-adherence and non-compliance.
In other words, changing medications can lead to a host of challenges for patients, especially our most vulnerable and at-risk patients. It would be alarming and point to this misguided approach. Limiting patients’ treatment options can tie the hands of the very professionals who serve and treat patients.
One solution, recently endorsed by the administration in a report, is better utilizing the pharmacist. Pharmacists have been and need to continue to be empowered as solutions to the concerns about the quality and the cost of medication treatments. We must address the barriers like payment for management services and the lack of recognition in Medicare as bonified providers for services. The solution has overwhelming bipartisan support in both the Senate and the House and has for the last 4 years.
Policymakers should take care not to let their population-based attempts at lower drug prices and patient protections unintentionally put individual patients’ health at risk and, instead, look no further than the most accessible and capable healthcare professional for medication management – both in quality and in cost.
Chad Worz, PharmD, is the executive director and CEO of the American Society of Consultant Pharmacists. www.ascp.com