Insurers want more autonomy to control drug costs

drugs

Health insurers that administer Medicare and Medicaid plans say legislators can ease drug costs by giving payers more leeway to evaluate drugs, a process that requires congressional action.

Executives made their case at last week’s National Conference on Medicare, Medicaid and Duals hosted by America’s Health Insurance Plans, arguing that regulatory changes would allow insurers to assess the value of certain high-cost drugs, according to MedPage Today. Although commercial plans can restrict formulary access to certain high-cost drugs with cheaper alternatives, insurers are handcuffed when it comes to Medicare and Medicaid plans.

Current regulatory statutes limit payers' ability to "manage as aggressively as we could" while ensuring patients have appropriate access to prescriptions, Sarah Marche, PharmD, vice president of pharmacy services at Highmark, told conference attendees, according to the article.

Others pointed to the uneven application of discounts for biosimilars, which can end up pricier than their predicate versions after rebates. Reports show Medicare Part D beneficiaries pay more for biosimilars than reference drugs and biosimilar manufacturers are less incentivized to offer drastically reduced prices.

Additionally, shifting specialty drugs to a two-tiered system would give insurers more negotiating leverage with drugmakers and spread premium decreases across the entire membership pool, according to Mark Owen, MBA, president of government programs for Health Care Service Corporation. He also advocated for limiting Part D drugs to specialty pharmacies in order to further reduce costs.