Dec 12, 2019

The Cost of Health

Roundtable attendees engage in conversation.

Theresa Carnegie of Mintz shares her perspective at the Axios roundtable. Photo: Hector Emanuel for Axios

This Tuesday, Axios' health care business reporter Bob Herman and Co-founder Mike Allen hosted an Expert Voices Live discussion on drug pricing and demystifying the pharmaceutical supply chain.

A broken system

While the discussion proved to be a lively debate, there was one area of agreement among attendees — the current health care system and its approach to drug pricing and coverage — is broken.

Attendees listening.
Sean Dickson and Marcie McClintic Coates look on as Robert DuBois speaks. Photo: Hector Emanuel for Axios
  • Robert DuBois, Chief Science Officer and Executive Vice President and the National Pharmaceutical Council, shared his opinion on high out of pocket costs: "Insurance is supposed to be the healthy subsidizing the sick, but with high out of pocket for drugs, it's the sick subsidizing the healthy."
  • Sean Dickson, Director of Health Policy at West Health, on the system: "The complexity of the system that we built well over a decade ago is contributing to the difficulty of reforming it."

Possible fixes

Herman asked the group if they saw relatively easy fixes to the current health care bills that would allow for widespread support.

  • Jennifer Bryant, Executive Vice President of Policy and Research at PhRMA, highlighted a topic of agreement among the table, "There are distorted incentives that are leading to less uptake of biosimilars and generics than we might otherwise see. One of the reasons is the incentive to put higher list-price products on formulary, and that penalizes patients the most."
  • Marcie McClintic Coates, Head of Global Policy at Mylan, stressed the importance of fixing the formulary tiers, "The formulary tiers still look like 2003, we've not kept a formulary tier for any speciality generics or biosimilars, we have a one-size-fits-all bucket."
  • Jack Hoadley, Researcher at Georgetown's Health Policy Institute, suggested solutions to encourage biosimilar penetration, "Some of it is just acceptance and education among the public and providers that biosimilars are a substitute, the other is figuring out — at several levels, including at the FDA — how to get biosimilars into the market."
Bob Herman talks with a guest.
Bob Herman and John Rother connect after the event. Photo: Hector Emanuel for Axios

More time, please

As the conversation came to a close, Bob Herman listed the topics he had hoped to cover with the group — the Institute for Clinical and Economic Review's reports, rebates, and an alternative system for drug pricing — if they had more time. The discussion concluded with the following key insights:

  • Matt Kazan, Principal at Avalere, spoke about his time on the hill and the three things needed to get bills like H.R.3 get passed, "Members of Congress can explain the provision at home, it's bipartisan, and the Congressional Budget Office says it saves money."
Michael Budros speaks.
Michael Budros of Healthsperien at the Axios roundtable. Photo: Hector Emanuel for Axios
  • Michael Budros, Policy Director at Healthsperien, mentioned one topic left out of the conversation, "We haven't talked about how drugs and prices connect to the value to patients...It's something to think about in future iterations of price and cost reform."

Thank you, Mylan for sponsoring this event.

Go deeper