PhRMA hits back at payers with new site highlighting coverage shortfalls

John Castellani

U.S. payers have generated a lot of ink protesting against high drug prices. After all, headlines about expensive meds--and patients who can't get them--are catnip for readers.

But the pharma industry has started its own offensive. The trade group PhRMA is rallying behind an argument shifting the blame for access problems to the insurance industry. After the group's chief, John Castellani, suggested as much on "60 Minutes" a week ago, PhRMA is unveiling a new website, AccessBetterCoverage, to explain the hurdles insurers are raising to drug reimbursement.

As PhRMA notes in its press release, a series of videos explains copays and coinsurance, and how formularies and tiers work. The essential message? Dear patients, this is how insurers try to keep you from the treatments you want.

Explaining drug reimbursement and insurance coverage in general isn't without its public service benefits. Insurers do tend to use confusing jargon and legalese when disclosing their coverage benefits, and it takes some math skills to run numbers on patients' share of costs for various drugs and procedures. To really compare health plans, those numbers are necessary.

Still, PhRMA has its obvious agenda, which includes pointing out the shortcomings of plans offered under the Affordable Care Act. Hence the story link at the bottom of the AccessBetterCoverage home page: Health Plans Are Shifting Specialty Rx Costs To You. From USA Today and Kaiser Health News, the story highlights the 20% co-insurance--up to 40% in some cases--that many patients have to pay for pricey meds. Or the "Unable to Meet the Deductible or the Doctor" article originally published in The New York Times.

Again, there's no denying that large copays are a problem for many patients, and they obviously hurt low-income people most. Insurance plans seem to be doing their best to shut Obamacare patients out of costly treatments by hiking copays on people who obviously can't afford them. Comparing the various offerings on Obamacare exchanges is confusing at best, even for people who are handy with their pocket calculators.

But there's no mistaking the subtext--which is hardly beneath the surface in the links to PhRMA's Catalyst Blog, where posts feature large graphics highlighting the cost burden imposed by Obamacare plans for various medicine types--diabetes, MS, cancer.

Nowhere--except near the bottom of the USA Today piece--is mention of the drug industry's role in access to drugs. Recently, the head of the U.K.'s cost-effectiveness watchdog, Sir Andrew Dillon, said that if drugmakers aren't happy with coverage decisions on their products, then they should cut their prices. The USA Today article quotes an insurance association rep making a similar comment.

With more and more pricey drugs coming out of pharma pipelines, and payers unafraid to criticize, expect more of this sort of argument. The only way the blame-shifting is likely to end is with an actual, substantive public debate. Given the polarized politics in the U.S. and American squeamishness about addressing the cost of drugs for terminally ill patients, that debate isn't likely to take place anytime soon.

- read the PhRMA release
- check out the AccessBetterCoverage site

Special Reports: The top 10 most expensive drugs of 2013 | 10 big brands keep pumping out big bucks, with a little help from price hikes

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