The Department of Health and Human Services won’t be able to bring down prices in Part D without “pitting drugs against each other,” Secretary Alex Azar said Tuesday.
The HHS head said that the agency is aware step therapy and other similar approaches can require a greater need for prior authorization or can create confusion about which drugs are available—but having these tools at a plan's disposal is crucial.
“Any talk about lower drug prices in Part D without a way to pit drug options against each other is really just hot air and empty promises,” Azar said at the American Medical Association’s National Advocacy Conference.
Part D plans have traditionally used step therapy as an option to manage costly conditions like diabetes and or high cholesterol—and the Centers for Medicare & Medicaid Services has proposed extending the option to Medicare Advantage plans to use in Part B.
Provider groups—including the AMA—have pushed back on that idea.
Though Azar’s speech focused on changes in Part D, he said HHS is listening closely to what physicians and groups like AMA have to say about the pieces of their drug pricing blueprint. He noted that AMA’s comments in response to the agency’s accompanying request for information said doctors are frequently unaware of what medications are on the formulary for a patient’s plan.
To ease some of the burden associated with step therapy, he said HHS has proposed a requirement that Part D plans use a pharmacy benefit tool that would make more information about coverage immediately accessible electronically.
.@SecAzar to #AMANAC: “Physicians’ voices are vital to delivering the outcomes we all want: lower prescription drug prices and better care for American patients at a lower cost.” pic.twitter.com/mkxNiGiLHs— James L. Madara, M.D. (@CEO_AMA) February 12, 2019
In addition, CMS proposed in a rule earlier this week enforcing the use of tools that would allow data to better follow patients between plans, as they may have to start a step therapy regimen over if they enroll in a new health plan.
HHS wants to hear from doctors on how to address this concern, he said.
“This is not just potentially injurious to [a patient’s] health—it's also pennywise and pound foolish,” Azar said. “We know that getting a patient on the right drug, at the right time, is one of the best investments we can make in their health.”
Azar stumps for agency’s International Pricing Index
In addition to focusing on HHS’ plans for Part D, Azar also took time in the speech to promote its International Pricing Index model, which would peg the prices of Part B drugs to those paid in other countries.
One of the plans’ more curious features is the role that drug vendors would play. Azar said that the goal is to provide options to providers who may not be able to spend significant amounts of upfront money to keep certain Part B products in stock.
An individual physician practice, for example, would have the option to hire a vendor to do their negotiations, and that vendor would own the drugs themselves. However, if a larger physician group has the leverage to do their own negotiating, that’s also an option, he said.
While the model’s central goal is to eliminate a “corporate welfare system” that benefits drug manufacturers, physicians were also considered in the model’s design.
“We believe that the lower costs will, of course, mean better patient access to drugs, better adherence and better outcomes for the care you provide—that is the goal,” Azar said.