Formulary Practices Hurting Patients

Hannah Wolf  0:03  
Welcome to Health Care Policy Pop. I'm Hannah Wolf. It's Thursday, October 26 2023.

Today's pop topics, Patients Rising has a new working paper on formulary practices. And the Congressional Budget Office is asking for more research regarding obesity. We'll tell you why that matters. But let's begin with that working paper titled "Equitable Access, Examining Discriminatory and Restrictive Practices and Prescription Drug Formularies." MacKay Jimeson with the Patients Rising patient access and affordability project tells us about the data and why it's needed 

MacKay Jimeson  0:44  
Our working paper is looking to address the harms caused by these complex formularies. And looking at specific policy reforms, policy papers need to focus on increasing transparency, prohibit unethical practices like lasering, encourage more open formularies, and require generics and biosimilars to be placed on the lowest cost tier to ensure that we're having markets that enable competition, lower prices, and give patients broad access to the medicines that they need. 

Hannah Wolf  1:12  
How are these tactics harming patients? Here's Jimeson. 

MacKay Jimeson  1:17  
Many of these discriminatory formulary practices use things like adverse tiering, or lasering, which disproportionately impacts patients that have chronic or severe conditions. These are the sickest of sick patients, and they wind up losing out on their pharmacy benefit as a result of these practices. What happens here is they can create hurdles so that patients struggle to get access to the specialty medicine that they need. Or they can create utilization restrictions, such as prior authorization step therapy, in some cases, patients are completely lasered out. So they don't even have access to that benefit that they rely on from their health insurer. 

Hannah Wolf  1:51  
So what do advocacy groups want Congress to do? 

MacKay Jimeson  1:55  
We believe Congress needs to number one: focus on transparency among PBMs. And that transparency will ultimately lead to reform and that reform can come down in terms of eliminating unethical practices like lasering, as well as ensuring that we follow the money supply so that patients are actually getting the best end of the deal when it comes to getting their prescription drugs. 

Hannah Wolf  2:18  
You can find the full working paper by using the link in the show notes.

The Congressional Budget Office is asking for more research in the area of obesity. A recent blog article by CBO director Phil Swagel tells us why. CBO is working to determine how much it would cost to cover weight loss medications that are hitting the market right now, versus how much those drugs might save and potential healthcare costs down the line. Ike Brannon is a senior fellow at the Jack Kemp foundation and explains

Ike Brannon  2:56  
The question is if these drugs cost $1,000 or more, how much would that cost the government and the potential given the number of people who are clinically obese in the country, the potential costs could be enormous. So you know, there have been some estimates that at the end of the decade, total money spent on these drugs could exceed $100 billion dollars a year.

Hannah Wolf  3:18  
Brannon gives us a summary of the blog by the CBO director.

Ike Brannon  3:22  
There's a notion that if you were to help people lose a lot of weight, especially with clinically obese, a lot of their health problems would go away and it would save Medicare and Medicaid money. And all he said was, you know, given the limited amount of data they have on this particular drug, they don't think that that would happen.

Hannah Wolf  3:41  
While the cost of these drugs needs to be examined Brannon and says Washington should continue to consider this situation holistically. 

Ike Brannon  3:51  
We need to think more broadly about societal benefits and not think about it in terms of the narrow impacts and budgets. We've just begun thinking about all the other types of benefits that might be out there for society.

Hannah Wolf  4:05  
Brannon spoke at length about the issue on the latest episode of the Patients Rising Podcast, you can find a link to that episode along with a link to the CBO blog piece in the show notes.

Finally, today, a recent stat news article says the FDA is authorizing more AI enabled medical devices. The FDA has released a new tally of artificial intelligence tools cleared for use and healthcare, and they expect the number of new authorized devices to be 30% more than the previous year. In a recent episode of this show, we explore the possible impacts of AI on health care moving forward. We will link to that episode in the show notes. That's all for today. We're back on Tuesday for another health care policy pop a resource of Patients Rising Now I'm Hannah Wolf, have a great day.