Cutting costs for prescription drugs shouldn’t mean cutting access to care

Patients who face high out-of-pocket costs for their prescription drugs are too often forced to decide between purchasing their medicine or putting food on the table. In Maryland, many of the highest-cost prescription drugs treat conditions that disproportionately impact seniors and Black patients, such as diabetes and sickle cell disease. Not filling, delaying, or curtailing the use of prescription medications for such conditions can have life-threatening consequences.

In response, Maryland is carving its own path to protect residents from high out-of-pocket prescription drug costs and the potential adverse health outcomes that can ensue. In 2019, the General Assembly created the Prescription Drug Affordability Board (PDAB), an independent board of government appointees tasked with identifying ways to improve prescription drug affordability. The PDAB is currently studying how policies enacted in other states and countries have lowered prescription drug costs.

While this all sounds very promising, the patient’s needs must be at the center of any ideas the PDAB chooses to adopt. As the famous economist John Maynard Keynes observed, “The difficulty lies not so much in developing new ideas as in escaping from old ones.”

The PDAB recently met to review policy options that other states and jurisdictions have enacted in attempts to lower prescription drug prices. Unfortunately, many of the ideas discussed are old ones which have been peddled by the Institute for Clinical and Economic Review (ICER).

The institute is an organization purportedly dedicated to creating cost analysis reports to inform “policy decisions that lead to a more effective, efficient, and just health care system,” but instead provides a rationale for insurance companies to deny patients access to innovative medical treatments.

One policy that was discussed during this recent meeting is a model law that would recklessly cut access to certain prescription drugs based on an arbitrary determination that those drugs had “unsupported price increases” in a given year.

Supported by the institute and the National Academy for State Health Policy, the law would significantly affect low-income seniors and people with disabilities in the Medicaid program; as well as state and local government employees; and retirees whose health care costs are funded by public programs. Drugs studied by ICER to justify this policy vary from year to year and include medications for which no other treatment currently exists.

Worth of a life

Another outdated, ubiquitous practice by ICER is the use of a discriminatory algorithm called the Quality-Adjusted Life Year, or QALY. QALY analyses are based on the premise that an older person living with a disease or a person of any age living with a disability is economically worth less than a younger or healthier patient receiving the same treatment.

This is a significant issue for Black individuals since QALYs dictate that worth is proportionate to life expectancy. Black Americans maintain a shorter life expectancy than whites, which forces the cost-effectiveness threshold for treatment to rise and is a significant concern for any Medicaid patient who needs prescription medications.

The state’s Prescription Drug Affordability Board also reviewed other policies to lower prescription drug prices during the meeting, including setting upper payment limits, reverse auctions, and bulk purchases. However, throughout the meeting, the direct impact of the policies on patients was never addressed.

When it comes down to it, any policy the affordability board adopts to lower drug prices needs to ensure that patients feel relief in their wallets and at the pharmacy counter. Complicated and discriminatory schemes such as those supported by ICER don’t consider the patient’s well-being and would lead to fewer innovative treatments for patients.

As a Maryland resident and advocate for older adults, I have to wonder if the PDAB will focus its efforts on preserving treatment access for patients and people with disabilities, or if it will align itself with an organization like ICER? Considering all that is at stake, I certainly hope they won’t choose the latter.

There is no question that high prescription drug costs require immediate attention. But the affordability board needs to find solutions that are not biased against seniors, people with disabilities, and people of color.

Maryland PDAB, beware.

Susan Peschin, is president and CEO of the Alliance for Aging Research.