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Pharmacy Outlook: John O’Brien, NPC

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Pharmacists are a vital part of the value chain.

As we head full steam into 2022, it is my hope that the new year brings about a much more informed public discussion about the important role prescription drugs play in our health care system and in improving the lives of patients.

John O'Brien

John O’Brien

That would be a marked change from the past year, which prioritized rhetoric and politics over an evidence-based understanding of the health care value chain and the challenges patients face at the pharmacy counter.

At the National Pharmaceutical Council, this year we intend to play a significant role in fostering a much more informed, evidence-based dialogue. Through our health policy research and partnerships, we will focus significant time on examining and explaining the true cost of prescription drugs and the value they provide. We also want to bring about a much greater understanding of the health care value chain, including the sometimes-perplexing incentives that can distort the most important parts of health care delivery.

Pharmacists are a vital part of that value chain, with roles that have evolved dramatically in the two decades-plus since I went to pharmacy school. In recent years, it’s become clear that patients rely on their pharmacists as the focal point of interaction with an increasingly complex health care system.

The pandemic made that especially true, as pharmacies have become the linchpin for delivering the COVID vaccines developed by innovative biopharmaceutical companies. During a time of disruption, pharmacies and pharmacists helped ensure that patients would have ongoing access to their medications and vaccines.

Yet what patients also face as they approach the pharmacy counter is an increasingly burdensome insurance system that forces them to pay even more out of their own pocket for the medicines they need. In terms every pharmacist can relate to, over 55 million prescriptions were abandoned in 2020, an IQVIA report showed, and higher out-of-pocket costs correlated to higher rates of abandonment.

Of course, pharmacies are not benefitting from any of this. They are facing the bewilderingly complex system of rebates and DIR fees that even the most seasoned policy makers misunderstand, much less the physicians and pharmacists trying to make sure patients get the medicines they need. Mix in the growing number of accumulators and maximizers, and patients and pharmacists are more likely to spend time on hold with an insurance company help desk than they are discussing how to best use their medicines.

What NPC plans to do more of in 2022 is to shine a spotlight on areas of this opaque system that ought to have more transparency. We want to play a key role in showing, with credible research, how policy makers and others can make sense of this topic.

It is my view that a lot of the misunderstanding about drug pricing, in fact, is caused by this system of rebates and fees and gross-versus-net price confusion. Transparency in the rebate and other payment systems, like 340B programs, is sorely lacking and is greatly needed.

Our debate about drug pricing would be vastly better informed if policy makers knew more about the relationship between what the patient is actually paying and which entities are actually getting paid.

It’s clear, though, that those extra costs the patients are paying at the counter have virtually no relation to what is happening with drug prices. Over the last three years, net prices for drugs have risen less than inflation, and in 2020 prices actually declined 2.9%.

As any pharmacist knows, the main stress at the pharmacy counter for patients is driven by their insurance: high deductibles, co-insurance, co-pay accumulators, step therapy and other drug utilization management barriers. These roadblocks are ostensibly designed to save money, but they often stand in the way of getting high-value care for the chronic conditions that drive so much of health spending.

There are solutions, however, that can get high-value treatments to patients in ways that make sense for the bottom line. Research shows that insurance that focuses on first-dollar coverage for chronic disease prevention would save employees and employers money.

IRS rules now let employers offering high-deductible health plans with health savings accounts cover an expanded list of preventive services and medications before patients meet their annual deductible. Nearly half of all large employers have taken this step, which not only saves patients money but saves downstream costs such as hospitalization and emergency department visits.

One aspect of the pharmacy that has continued to amaze me during this pandemic: I’ve yet to meet a rude or angry pharmacist. The customer-centric, patient-focused approach goes along way, and it would be very nice if insurers adopted it. That would be a welcome change — a study by NPC and Tufts Medical Center’s Center for the Evaluation of Value and Risk in Health showed almost half of the health plan decision makers surveyed reported never having engaged with patients when developing coverage policies.

Just as pharmacists should not be taken for granted, neither should the impact of innovative medicines on our overall health. People now live with HIV instead of dying from it, and people with hepatitis C now can be cured. Broadly, NPC research found that for eight different medical conditions, physicians attributed more than half of the improvement in outcomes over a 20-year period to medications, more than any other medical innovation.

The promise that innovation brings to people’s lives is why a kid who grew up wanting to be a sports broadcaster decided instead to go to pharmacy school. As a pharmacist, I saw first-hand how small advances in science make a huge difference for patients. I’ve also seen it as a son, because, thanks to medicines and better treatment, both my parents transitioned from cancer patients to cancer survivors.

And today, as head of NPC, I hope to see and lead efforts to bring all health care stakeholders together to preserve and improve access to the innovations of the future, ones that may cure or manage a chronic condition or defeat the next pandemic.

As we debate the future, NPC will continue to focus on evidence-based ways to maintain incentives for innovation that promote high-value care. These are incentives not just for the biopharmaceutical sector, but across our health care system, to make sure people get access to the care and treatments that they need.

John O’Brien is the president, CEO of the National Pharmaceutical Council.


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