The Prescriptin Drug Cpayment Cupn Landscape Geffrey Jyce, PhD, Karen Van Nuys, PhD, Rci Riber, PhD and Dana P. Gldman, PhD Lenard D. Schaeffer Center fr Health Plicy & Ecnmics, USC
DISCLOSURES This wrk was supprted by the Lenard D. Schaeffer Center fr Health Plicy & Ecnmics and by the Natinal Institute n Aging f the Natinal Institutes f Health under Award Number P01AG033559. The cntent is slely the respnsibility f the authrs and des nt necessarily represent the fficial views f the Natinal Institutes f Health r the Schaeffer Center.
Average Price f Humira (2 Syringes, 2015) $2,669 $1,362 $822 Switzerland United Kingdm United States Surce: Internatinal Federatin f Health Plans 2015 Cmparative Price Reprt 3
Mst Americans favr actin t keep drug prices dwn Requiring drug cmpanies t release infrmatin t the public n hw they set their drug prices 86% Allwing Medicare t negtiate with drug cmpanies fr lwer drug prices 82% Limiting the amunt drug cmpanies can charge fr high-cst drugs fr illnesses like hepatitis r cancer 78% Allwing Americans t buy prescriptin drugs imprted frm Canada 71% Surce: KFF Tracking Pll, Sept 2016 4
Distributin f Cst-sharing Payments fr Rx Drugs in Large Emplyer Plans Rx deductible spending Rx cinsurance spending Rx cpay spending 2004 4% 3% 93% 2005 4% 4% 92% 2006 8% 6% 85% 2007 10% 9% 81% 2008 11% 8% 82% 2009 11% 8% 82% 2010 14% 7% 78% 2011 17% 11% 72% 2012 16% 15% 69% 2013 19% 17% 64% 2014 24% 20% 56% Surce: Kaiser Family Fundatin analysis f Truven Health Analytics MarketScan Cmmercial Claims and Encunters Database, 2004-2014 5
Shuld Cpay Cupns Be Banned? Offered by pharmaceutical manufacturers Increasingly cmmn, but cntrversial tl t address high ut-f-pcket csts Currently banned frm federal prgrams Banned in MA, but repealed in 2012 Several states (CA AB-265) prhibit cupns fr drugs with a generic equivalent Respnse f cmmercial plans N credit twards deductible 6
Plicy Questin Shuld gvernment enact legislatin banning cpay cupns? Cpay cupns reduce r eliminate cpayment required by the health plan Glass half-full: Imprves access by reducing patient ut-f-pcket csts Glass half-empty: Circumvents plan benefit design Patients fill mre expensive therapies, raising ttal drug expenditures 7
Cupn and Generic Status f 200 Highest-Expenditure Drugs in 2014 200 Highest Expenditure Drugs in 2014 68 Generics 132 Brand Name 42 N Cupn 90 With Cupns 12 Cmpeting with Generic Equivalent 7 Facing Generic Entrant 71 N Generic Equivalent 25 Generic CTS 35 Only Single- Surce CTS 11 N CTS Cupned Drugs Brand Name Drugs 8
Distributin f Mnthly Cpay Gal 45% 12% Distributin f Annual Aid Cap 28% 32% 48% 15% Distributin f Duratin 52% <$5 $5-$10 $10.01-$25 >$25 14% 6% <$500 $500-$1000 $1000.01-$10000 47% >$10000 Mentin N Mentin 33 Distributin f Duratin Types 19 15 Set # Uses Set Date Set Duratin 9
Cupn and Generic Status f 200 Highest-Expenditure Drugs in 2014 200 Highest Expenditure Drugs in 2014 68 Generics 132 Brand Name 42 N Cupn 90 With Cupns 12 Cmpeting with Generic Equivalent 7 Facing Generic Entrant 71 N Generic Equivalent 25 Generic CTS 35 Only Single- Surce CTS 11 N CTS Cupned Drugs Brand Name Drugs 10
Cupn and Generic Status f 200 Highest-Expenditure Drugs in 2014 200 Highest Expenditure Drugs in 2014 68 Generics 132 Brand Name 42 N Cupn 90 With Cupns 12 Cmpeting with Generic Equivalent 7 Facing Generic Entrant 71 N Generic Equivalent 25 Generic CTS 35 Only Single- Surce CTS 11 N CTS Cupned Drugs Brand Name Drugs 11
Clse Therapeutic Substitutes f 71 Single-Surce Cupned Drugs Distributin by Type f CTS 35 5 9 21 N Cupned Drugs Amng LPCTS CTS has Cupned Drugs, LPCTS nt Cupned LPCTS is Cupned 25 11 N CTS Generic CTS Only SS CTS 12
Likely Impact f Cupns n Differing Cmpetitive Landscapes Lwers Drugs with nly branded CTS BETTER 35 Impact n Expenditures Drugs with generic equivalent Drugs with generic CTS Drugs with n CTS 11 19 25 Raises WORSE Neutral Impact n Therapeutic Optins Expands 13
Summary f Findings (2014) Cupns are a strategic respnse t Higher patient cst-sharing PBM cntrl and cnslidatin (pick winners & lsers) Can weaken frmulary cmpliance 1 in 5 cupns steer patients away frm generic equivalent 1 in 8 cupns are fr single-surce drugs with n clse therapeutic substitute Remaining cupns (2/3rd) are fr drugs with imperfect therapeutic substitutes 40% have a CTS that is generic 60% have nly branded CTS (ften similar in price; mst als cupned) 14
Ttal Ban is Unwarranted Cupns are a symptm, nt the disease Ban wuld reduce access fr sme patients At least cupns direct savings t the user Ttal ban favrs ne part f the supply chain (PBMs and payers) ver anther (manufacturers) While many are cmplicit in rising drug csts Ecnmic rents (prfit) shuld be prprtinal t the value added Manufacturers take biggest risk and are the primary innvatrs in the industry 15
healthplicy.usc.edu blg: evidencebase.usc.edu facebk.cm/schaeffercenter @SchaefferCenter