Good Day BIO: ‘A way to discriminate against sick patients’

The new episode of the I am BIO Podcast explores the distorted drug pricing system—and how it discriminates against the sickest patients. BIO’s supporting a new voluntary framework for responsibly using gene editing within food and agriculture. (665 words, 3 minutes, 19 seconds)

‘A way to discriminate against sick patients’

The convoluted, confusing, and opaque system for pricing drugs is distorting the market—and limiting access to the sickest patients. In the latest episode of the I am BIO Podcast, three experts explain how the system works (or doesn’t) and the consequences for patients.

“There is a lot of variability in the prices that patients will pay for drugs,” says Anna Hyde, VP of Advocacy and Access for the Arthritis Foundation.

Thank PBMs—a.k.a. pharmacy benefit managers, which manage prescription drug benefits on behalf of health insurers (and are often owned by the insurers).

“It’s reverse insurance,” says Dan Durham, BIO’s Senior Health Policy Advisor. “So while the health plans may claim, ‘We're using rebates to reduce everyone's premium,’ the fact of the matter is, the sickest patients pay the highest out-of-pocket cost based on the list price.” As a result, many don’t buy the medicine and their health deteriorates, which drives up other health care expenses.

The numbers tell the truth:Rebates, discounts, and other payments from drug developers reduced the list price of brand medicines by 49% on average in 2021. Unfortunately, too often, insurers and middlemen/PBMs don’t share these savings with patients at the pharmacy, which leads to higher out-of-pocket costs—and a recent study found hospitals mark up the price of cancer drugs by as much as 630%.

“It’s possible that a hospital could earn more revenue per unit from a drug than the pharmaceutical manufacturer that developed the drug,” says Dr. Vinay Rathi of Massachusetts Eye and Ear and Mass General Brigham, one of the authors of the study. Even using what he calls a “conservative approach,” the lowest medium markup was over 100% in excess of drug acquisition costs.

It's “a way to discriminate against sick patients,” concludes BIO’s Durham. The Affordable Care Act outlawed health plans discriminating based on health status or pre-existing conditions, so now, they don't pass on the negotiated savings to the patient "because they view that as one way of keeping the sick patients out of their health plan."

Listen: Click here to listen to the episode now or listen via Apple, Google, Spotify, or wherever you get your podcasts.

More Reading:

• What are PBMs, anyway?
• Hospitals mark up price of cancer drugs by as much as 630%, says study
• Senate hearing: PBMs ‘part of a broken drug supply chain’

New framework promotes gene editing transparency

The Coalition for Responsible Gene Editing in Agriculture developed a voluntary framework for responsibly using gene editing within food and agriculture—and BIO supports it.

The framework: Developed by a multi-stakeholder coalition, the framework outlines “principles and commitments that organizations voluntarily follow to demonstrate their willingness to be transparent about their use of gene editing and desired outcomes that benefit the food system, environment and society as a whole.”

Click here to download the framework.

Why it matters: “Gene editing has tremendous potential to benefit our entire food production system from the farmer to the consumer,” says Charlie Arnot, CEO of The Center for Food Integrity (CFI), which administers the coalition. “These benefits will only be realized if consumers trust that the resulting products are safe and understand how using gene editing technology helps achieve goals that align with broader social goals like producing the food we need with less environmental impact and reducing pests and disease in crops and livestock.”

BIO supports the framework—along with BIO member companies including Genus PLC, and Tropic Biosciences.

BIO’s take: “Innovation flourishes when science and consumer values are aligned and complement one another,” says Sarah Gallo, BIO’s VP of Agriculture and Environment. “This framework establishes a process to examine meaningful criteria in an objective, predictable and consistent way—characteristics that are important to technology developers, as well as stakeholders looking to endorse innovation in product development.”

Read more about BIO's efforts to grow trust in innovation. 

President Biden’s Tuesday: He’s traveling to Buffalo, New York, to meet with families of the victims of Saturday’s shooting, then returning to the White House for a reception to celebrate Asian American, Native Hawaiian, and Pacific Islander Heritage Month. The FDA is expected to soon authorize a Pfizer booster shot for children ages 5-11 as early as today, reports The Washington Post.

What’s Happening on Capitol Hill: Budget hearings continue in the House and Senate, with EPA Administrator Michael S. Regan testifying before the House Energy and Commerce Environment and Climate Change Subcommittee, and NIH’s Dr. Fauci testifying before the Senate Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies.