Patients want transparency. In recent years, patients are facing higher deductibles and higher premiums according to the Kaiser Family Foundation, KFF. Patients are also seeing complex and unclear pricing when it comes to routine checkups and medical tests.
In some cases, these complex pricing databases help knowledgeable patients compare prices refeeding medical procedures. In most cases, most about pricing in the big pharma world are still a mystery to them. More patients demand pharma pricing transparency than ever.
Most of the claims that were reported in 2013 involved overpayments, about 23% of the 9.5 million claims.
These overpayment reports totaled $135 million in 2013. Many of these cases involved generic medication being marked up when compared to medication in the pharmacy. When it came to branded medication, about 6% of claims, overpayments came in at twice as high with overpayment $13.46 per claim.
There was a survey done from a National Community Pharmacists Association, NCPA, in which a survey of 628 pharmacies, 49% claimed to have seen 10-50 cases of “clawback fees”, which is money that has been given out and required to be returned. “Gag clauses”, or non-disclosure agreements, where pharmacists cannot give information to patients when their copay exceeds the cost of filling the prescription have gained media coverage. Senator Susan Collins describes that the American public has the right to know which payment method, cash or insurance, would save the patient the most money.
Pharmacy benefit managers, PBMs, will serve as a middleman between pharmaceutical companies and pharmacies to deal with prices. They are the negotiators when it comes to insurers in the form of rebates. Instead of saving patients more money, insurers are using these rebates to offer lower premiums.
The Trump Administration has outlined a plan in their “American Patients First” plan including reducing drug prices and out-of-pocket costs. Other elements include: eliminating regulations, such as the Risk Evaluation and Mitigating Strategies, REMS, requirements manufacturers to avoid sending samples to creators of generics, allowing greater substitution in medicine, including list prices in pharma advertising, restricting rebates, and eliminating gag clauses or clawback fees.
MarketWatch sees little to worry about, predicting, “[the plan] isn’t expected to hurt drug makers or pharmacy-system middlemen.” Meanwhile, Forbes claims, “[the plan] represents a sea of change in pharmaceutical pricing policy, one that will have a significant effect on drug prices in the future.”
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