Good Day BIO: ‘A way to discriminate against sick patients’
May 17, 2022
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,…
The only newsletter at the intersection of biotech, politics, and policy
May 17, 2022
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.
“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."
STAT News: Russian aggression underscores the U.S.'s need for greater investment in medical countermeasures "Russia is creating the possibility of a chemical, biological, radiological, and nuclear (CBRN) nightmare. Its aggression against Ukraine makes it clear that American investment in innovative medical countermeasures is long overdue. U.S. policymakers must ensure that this country is as ready as it can be before the worst comes calling," writes BIO's President and CEO Dr. Michelle McMurry-Heath and co-chair of the Bipartisan Commission on Biodefense and former U.S. Senator Joseph Lieberman.
The BIO International Convention is back in person—and we’re excited to welcome guests from around the world for a fun-filled week of partnering, networking, and education in San Diego.
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.”
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.”
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.