This week, Dr. Peter Bach of Memorial Sloan-Kettering Cancer Center authored an op-ed about the cost of prescription medicines within state Medicaid programs. The opinion piece fails to mention several key points that patients and policymakers deserve to know. In response, BIO Communications submitted the following comments:
There are few important points Dr. Bach either glosses over or fails to mention entirely.
First, drugmakers are required by law to provide significant rebates to state Medicaid programs to help provide access to innovative medicines. These rebates reduce the list prices for innovative drugs by at least 23.1 percent. Then there is the “best price” rule, which requires drugmakers to provide Medicaid the lowest price offered to any other entity in the marketplace. Medicaid is entitled to whichever concession – the 23.1% rebate or “best price” – leads to the best possible deal for taxpayers.
States may then demand supplemental rebates in addition to these federal requirements, all of which help provide low-income patients access to innovative medicines at a lower cost to taxpayers. To leave the impression that Medicaid might pay the full price for a prescription medicine is grossly misleading.
Second, ICER has a habit of relying on hypothetical assumptions derived from a non-transparent system to promote their preconceived notions about the value of innovative biopharmaceutical medicines. No one knows for certain what assumptions ICER bases its reviews on, because much of its work remains shrouded in secrecy.
Also, more often than not, ICER’s views stand in stark contrast to those of physicians and patients who understand the true value of biomedical innovation. That was the case during last week’s hearing in New York, which this column also fails to mention. Instead of holding up ICER’s black-box approach as the gospel, we should all view its work with a great deal of skepticism.