No Patient Left Behind

NPLB's new Innovation Council is lucky to benefit from the expertise of Alexandra Urman, MPH; Grace Colón; Amanda Banks, MD; Dr. Jeremy M. Levin; Paul Hastings; and Paul T. Kim. Their broad experience and unique talents will help advance our research & education efforts in support of biotech affordability & innovation. Thank you for your help and guidance! https://lnkd.in/e4mNs8Cx

Great to see legislation introduced to cap Rx out-of-pocket costs at $2000 per year for Americans in commercial (employer & ACA exchange) plans. Enacting an Rx OOP cap and #PBM reform would make this an excellent Congress for patients -- which is to say all of us. #FixInsurance https://lnkd.in/efytNBAv

There are scientists everywhere among us and we all play a role in biomedical progress. Check out this guest op-ed from Cony D'Cruz that shares his inspiration for innovation and how Superluminal Medicines Inc. is working to improve patient health in his hometown of Mercersburg, PA and across the country. He also shares how Congress can fix #IRA to ensure US biotech leadership & affordability. https://lnkd.in/eKQx6ryr

Hopefully today's Federal Trade Commission "interim" report will help Congress get #PBM reform over the finish line this year. Report illustrates how "PBMs wield enormous power over patients’ ability to access and afford their prescription drugs, allowing PBMs to significantly influence what drugs are available and at what price." It also quantifies how "PBMs are highly concentrated and vertically integrated with the nation’s largest health insurers and specialty and retail pharmacies." * PBMs oversee critical decisions about access to and affordability of life-saving medications, without transparency or accountability to the public. * Vertically integrated PBMs appear to have the ability and incentive to prefer their own affiliated businesses, creating conflicts of interest that can disadvantage unaffiliated pharmacies and increase prescription drug costs. * The top three PBMs processed nearly 80% of 6.6 billion prescriptions in 2023 & the top six PBMs processed more than 90%. * Pharmacies affiliated with the three largest PBMs now account for nearly 70% of all specialty drug revenue. https://lnkd.in/e9a-MHMF

Medicare Part D plans restrict access (e.g., prior authorize) to 50% of the drugs they claim to "cover". Let's Fix Insurance.

Medicare Advantage plans should be key to improving patient care while also bending the nation's health cost-curve. Hard to read today's The Wall Street Journal Christopher Weaver Tom McGinty Anna Wilde Mathews Mark Maremont story highlighting how MAPD plans sought higher Medicare payments to provide less or no beneficiary care. "Insurer-driven diagnoses by UnitedHealth for diseases that no doctor treated generated $8.7 billion in 2021 payments." Startling to read examples such as patients diagnosed with HIV either did not have the disease or were not being properly treated despite plans receiving higher payments. "Less than 17% of patients with insurer-driven HIV diagnoses were on antiretroviral drugs." Also depressing is the news that plans are charging beneficiaries high out-of-pocket costs for prescribed treatments and then still seeking higher payments from Medicare in subsequent years after the patient has been successfully treated. "Insurers subsequently told Medicare that more than half of the patients who had received the drug treatment still had hepatitis C in a future year, leading to millions of dollars in extra payments." Read the full story here: https://lnkd.in/e6mXrN8R

🚨 Exciting news! 🚨 We're officially back on Facebook! Using the platform, we aim to continue expanding our coalition of innovators, investors, economists, #healthcare professionals, patients, and others with a stake in a fair and ever improving healthcare system to support biomedical affordability and #innovation on a new platform. Follow us for more information and updates! https://lnkd.in/grsAs8nZ

Earlier this year KFF found that nearly half of voters say that lowering out-of-pocket costs is the top health care priority to address. #IRA's $2,000 Part D OOP cap will help begin to fix this, but CMS's proposal for the next round of government negotiated price-setting will neither improve patient access nor help ensure more & better medicines will be developed. We submitted formal comments on the proposed regulations. If the government is going to impose price controls on drugs, it needs to ensure that patients -- not health plans, #PBMs, nor health systems -- see those savings. Here's how @CMSGov can improve IRA's rules: 1. Ensure that price-set drugs are put on Part D & MAPD plans lowest OOP cost formulary tiers. 2. Don’t let health systems eat up Rx savings through markups. 3. Reject use of outdated cost-effectiveness analysis (CEA) calculations to set drug prices or limit beneficiary access. Read our full letter here: https://lnkd.in/ea2csQhr

New GoodRx data shows how vertically-integrated health plans and their #PBMs are increasing barriers for premium-paying customers to access prescribed treatments: ⛈ plans are increasing copays, coinsurance, & deductibles, ⛈ plans are adding new restrictions to "covered" treatments. How are plans cost-shifting to customers via more complexity and restrictions? ❌ Plans "cover" just 54% of prescribed drugs. ❌ 50% of Part D drugs have some form of admin restriction. ❌ 25% of Americans have at least one drug that their insurance doesn’t cover. What are premiums for anyway? https://lnkd.in/ePhqMqYf

Not just another #PBM story. Important Jared Hopkins reporting on 3 Axis Advisors data illustrates how vertically-integrated plans/pbms have squandered mail-order Rx's potential benefits: Patients should expect lower copays, national access, better adherence, & convenience. This is not hard to fix: Employers & CMS should demand savings are shared with payers and beneficiaries. https://lnkd.in/g-ydqu93