What would happen if drug price 'negotiation' brought down pharma list prices across the board? Not much at all, at least not for patients facing financial toxicity, according to most recent Xcenda research with payers.
This new survey confirms the market realities policy-makers should pay close attention to.
Most payers say they will stick with rebates and won’t change patient co-insurance/ co-pays. Some prefer to use the windfall to lower premiums in response to concerns of their customers, plan sponsors/ employers etc. While that certainly sounds appealing, it does little to address the affordability issues thanks to out-of-pocket costs in the US.
While not being asked about the negative innovation impact of a broad reduction in drug prices, these payers say that they would largely not reform benefit design. The sick would continuing to subsidize the healthy, as former FDA chief Scott Gottlieb once said.
To me this is yet another proof point that drug affordability cannot be tackled without reforming insurance benefit design.
Key takeaways
A 15% drug cost reduction would have limited impact on patient copays and coinsurance, say 35 payers, PBM and IDNs
46% would lower premiums to benefit plan sponsors
Almost 3 in 4 payers would be unlikely to change or broaden Part D coverage
40% would not make any changes to their commercial formularies
Only 1 of 4 payers would pass savings on to patients in the form of lower copays
Only 11% of payers would lower coinsurance
Data here: https://lnkd.in/drgFMHB
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