Opposing view: Health plans manage costs
21 04 08 - 14:46
Congress should promote studies, alternatives to pricey new drugs.
By Karen Ignagni
The development of new specialty biopharmaceuticals offers hope to all of us. These drugs make it possible to treat diseases for which there are few available therapies, and they provide new options where treatments already exist. But we face two challenges with these single-source drugs: their exorbitant price tags that bear little relation to the cost of producing them, and the lack of incentive for manufacturers to make these drugs more affordable.
Patients and doctors have no way to compare these new drugs with existing drugs, devices and therapies or to evaluate their safety and value. For many of them, there are no head-to-head studies showing whether they are better than existing treatments.
The data show that health plans have made major progress over the years in developing strategies to preserve access to prescription drugs while managing costs. The growth in spending on prescription drugs has stabilized, and studies have credited health plan programs - including tiered benefit structures - for making this possible. In fact, according to a federal actuaries, health insurance premiums grew at 5.5% from 2005 to 2006, the lowest rate in a decade.
Some health plans have responded to concerns about the price and lack of competition in biopharmaceuticals by creating specialty tiers for drugs that cost tens or even hundreds of thousands of dollars for a year's supply. These tiered plans often have caps on out-of-pocket costs. Others are using specialty tiers when alternatives are available on the plan's preferred drug list. Structuring benefits this way helps employers maintain coverage in the face of drug costs in this category, which have been rising as much as 20% a year recently.
To enhance access to these drugs and promote competition, Congress should pass legislation that encourages companies to develop generic alternatives to these very costly biopharmaceuticals.
Congress also should create a national institution to compare the effectiveness of new and existing therapies, and provide patients and doctors with data about which are safest, work the best and are most cost-effective. This would yield better health outcomes for patients and transform the health care system to one that is driven by research and rewards best practice.
Karen Ignagni is president and CEO of America's Health Insurance Plans, the national trade group for health insurance organizations.
Posted at 12:20 AM/ET, April 21, 2008 in Health care/Insurance - Editorial, Medical Issues - Editorial, USA TODAY editorial | Permalink