We Offered a Path to Lower Drug Prices And Gilead Listened

Our reimbursement system for medications is complex, but our intentions are clear: we want to ensure affordable access for patients and payers.

In our response to the Administration’s Drug Pricing Blueprint, we suggested a pathway for drug makers to introduce lower list prices for products that currently have high list prices and high rebates in a way that will not destabilize the drug supply chain, while giving cash-paying patients immediate access to more affordable medicine.

Today’s action by Gilead Sciences is a step in the right direction, and we are encouraged that a drug maker is taking meaningful action to bring prices down for cash-paying customers.

Can’t Drugmakers Just Lower the Price?

Drug makers set drug prices, and can lower them at any time.  While we do advocate for lower list prices, particularly when a new drug comes to market, immediate list price decreases for products already on the market do pose challenges in the broader pharmacy supply chain. For example, pharmacies and wholesalers have inventories of drugs at high prices that they would have to sell for less; plans have  underwritten  plan  offerings  and  benefit  designs  for  2018  and  2019,  based  on  existing economics.

By re-launching a brand product under a new National Drug Code (NDC) with a lower list price, we create a competitive dynamic more similar to a generic coming to market. Cash-paying patients can have immediate access to the lower-priced medication. Meanwhile, plans and PBMs can choose which product to cover that is best for their plan and their members:  the lower-priced option, or the original brand, which may have a rebate.

Over time, plans, pharmacies and the rest of the supply chain can transition to a  new  pricing  model and  the  drug  maker  could  ultimately  retire  their  high  list-price product.

Good News for People with Hepatitis C

Nothing is more important than being able to provide the best possible treatment to every patient who needs it.  When Sovaldi and Harvoni first came to market, they offered tremendous promise – a cure – to people with hepatitis C. But their costs put these medications out of reach for most, and many payers were forced to reserve coverage for just their sickest members.

In 2014, through our Hepatitis Cure Value (HCV) program, we leveraged competition in the class and took bold actions that brought down the cost of new hepatitis C therapy across the industry, and more importantly, opened up access to all people with hepatitis C, not just the sickest.  In addition to lower costs, our HCV program makes sure patients receive the most from their medication.  In 2017, 96% of patients who were prescribed hepatitis C therapy completed their treatment with the help of our specialist pharmacists and are now cured.

Today’s announcement is a win for payers and patients, who now will have more choice, more access and greater affordability.