When it comes to rising drug costs, payers and pharma rarely see eye-to-eye. But more back-and-forth conversation could go a long way in easing some of the tension, both sides are saying. And a little regulatory overhaul could help make this a possibility.
More dialogue between insurers and drugmakers would make the transition easier when pricey new meds hit the market, representatives from the pharma and insurance industry told Morning Consult. As of now, it’s unclear how much insurers and drug companies can communicate prior to a med’s launch, which makes it difficult for them have an honest conversation.
“We believe that companies should be able to have very frank exchanges proactively with the payer community so that payers are not surprised when potentially groundbreaking new medicines are approved by the FDA,” Jeff Francer, VP and senior counsel in the law department at PhRMA, told the news outlet.
Another part of the problem is that new drugs often hit the market after insurers set their rates for the year, Morning Consult points out. Insurers don’t have time to plan for the pricey launches, which sometimes means that plans or patients end up paying the price.
“Say for example, a drug comes out in September [or] October, and we didn’t have a window into what those costs would be. Plans didn’t anticipate or factor that into their rates. That could be a huge pressure for premiums. It could be a huge pressure for patient costs,” Clare Krusing, a spokeswoman for insurance industry group America’s Health Insurance Plans, told the news outlet.
To fix the issue, the FDA would probably have to step in. Congress is already pushing for this to happen. A provision in the 21st Century Cures bill, which has passed in the House, would require the FDA to tell drugmakers and insurers how they can exchange scientific and medical information before and after a drug is approved.
The Senate is also getting in on the effort. Eventually, lawmakers there want to create a broad medical package on the floor. A provision about insurer-drugmaker communication for new drug approvals could come up during the amendment process, Morning Consult points out.
A regulatory facelift for insurer-pharma communication laws would come at a critical moment. There are more than 2,300 drugs in late-phase development. And more than one-third of the 630 research programs in late phases are for specialty drugs, according to a recent IMS Institute for Healthcare Informatics report.
High prices for specialty meds often catch payers off-guard, and “it’s not helpful for payers to be surprised,” Francer said, as quoted by Morning Consult. “We feel it’s important to get this type of pipeline information to payers more quickly than they’re getting it now.”
- read the Morning Consult story
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