Is the Price Right?

Specialty Pharmacy Times, November/December 2015, Volume 6, Issue 6

AS 2015 COMES TO A CLOSE, it is fair to say that the year in specialty pharmacy has been tumultuous, to put it mildly.

Driven by the root problems that stem from the deeply-flawed Affordable Care Act, patients are being assailed by cost increases from growing insurance rates and higher deductibles that leave many out in the cold and unable to afford their medications.

In the wake of the recent controversies surrounding Turing Pharmaceuticals raising the cost of the drug Daraprim by 5000% and the relationship between manufacturer Valeant Pharmaceuticals and so-called specialty pharmacy Philidor Rx Services, medication spending has been placed squarely in the spotlight.

The cost of prescription drugs for patients is troubling for stakeholders across the health care landscape in an era when government overreach has ultimately limited the freedom of citizens in choosing their physicians and optimal insurance plan.

The growth of multitiered formularies that place specialty drugs on the fourth or fifth tier has resulted in out-of-pocket costs that are crippling to many patients.

A recent survey from the Deloitte Center for Health Solutions found that 1 in 3 individuals enrolled in public health insurance exchanges have trouble paying out-of-pocket costs for health care, while just 16% indicated they are financially prepared to handle future health care costs.

This collateral damage from Obamacare was all too predictable and just further illustrates the real world consequences of deceptive legislation that failed to significantly improve the lives of patients.

This is an issue that will continue to grow in importance, as analysis released this month by the IMS Institute for Healthcare Informatics showed total worldwide medication spending will reach $1.4 trillion by 2020 as a flood of breakthrough therapy innovations continues to hit the market.

The balance between reducing the price of specialty drugs for patients while still incentivizing innovative research must not end up limiting the freedom to profit in an open market. If we diminish the ability for manufacturers to recoup their investment in a specific product, we may ultimately limit the scope of future drug development.

In light of this growing conundrum, I urge you to read the article by Specialty Pharmacy Times editorial board member and Curant Health COO Marc O’Connor, who examines potential solutions to reduce drug costs based on the value a treatment brings, as opposed to just demonizing manufacturers for the price of breakthrough therapies.

Also in this issue is the latest editorial from Dan Steiber, RPh, our esteemed editor-in-chief, who addresses recent media reports that have misrepresented what constitutes a specialty pharmacy. Ultimately, it is the patient, not the price tag, that is at the center of a true specialty pharmacy.

As we start anew in 2016, the industry must continue fighting to prevent an uniformed media outlet from guiding the discussion that defines specialty on a larger scale. As we take on that battle together in the year ahead, we would like to wish you and your family a healthy, prosperous, and very happy New Year. SPT

Thank you for reading!

Mike Hennessy, Sr

Chairman and CEO