5 Things From the HHS Pharmaceutical Forum

HHS brought leaders from government agencies, pharmaceutical manufacturers, patient advocates, providers, employers, and payers at the HHS Pharmaceutical Forum to share ideas on delivering affordable but high-quality medicine, improving outcomes, and continuing to lead in innovation.

Susan Dentzer, senior policy adviser for The Robert Wood Johnson Foundation and forum moderator, opened the day and pointed out the challenge of ensuring an innovative and dynamic biopharmaceutical sector while keeping costs affordable and sustainable.

HHS Secretary Sylvia M. Burwell noted that no one wanted to choose between innovation and affordability and a healthcare system that works for its patients, and conversations between diverse stakeholders are crucial to solving the issue.

“As we work to strike the balance between fostering innovation and keeping drugs accessible and affordable we must let the principles of putting the consumer at the center guide our thinking,” she said.

Here are 5 things that came out of Friday’s HHS Pharmaceutical Forum.

1. All stakeholders want to move to value-based contracting.

Acting CMS Administrator Andy Slavitt told attendees that the government wanted their ideas about value-based payments. “Are we getting good value for consumers and taxpayers dollars?” he asked.

Brian Lehman, MBA, MHA, RPh, manager of pharmacy benefits and policy with the Ohio Public Employees Retirement System, said that his organization struggles to keep copays and premiums low and it really wants value-based contracts to work. The main barriers so far have been putting in place the infrastructure and getting the needed data.

2. The discussion of value is made more complicated because there are many ideas on what value means.

Mark McClellan, MD, PhD, senior fellow and director, Health Care Innovation and Value Initiatives, Brookings Institute, said that the discussion of value in pharmaceuticals is important and there are several components: the avoided healthcare costs farther down the road; avoided non-medical costs such as enabling people to get back to work or be more productive in their jobs; economic growth through high-quality jobs at the pharmaceutical company; and, most importantly, longer and better lives for Americans.

“I’ve talked to enough people to know that we don’t really have a common definition for that term [value based] yet,” said Bernard J. Tyson, chairman and CEO of Kaiser Permanente. “Depending on who is promoting value-based there is a view that one may or may not agree with.”

Marc Boutin, JD, CEO of the National Health Council, said that there needs to be a way to look at the entire healthcare ecosystem and collectively decide what is value and how to promote it. However, this cannot be done without the patient perspective.

“When you’re diagnosed with a disease for which there is no effective treatment or is deadly or you have a child who will wither and die before their 18th birthday, you have an entirely different perspective on what value is and what innovation is,” he said.

3. Everyone wants more transparency in multiple aspects of care.

Slavitt named transparency one of the domains where the government is looking to stakeholders for ideas. The industry knows that drug costs are often unclear due to a variety of factors. There are list prices, wholesale prices, rebates, markups from hospitals, formulary tiers, “and many other ways that end up obscuring the reality of the price paid, who pays it, and how all of it influences treatment decisions,” he said.

During the patient viewpoint panel, Health Block, a consumer advocate who has cancer, noted that the drug she is on at the same dosage has gone through a number of price changes from a few hundred dollars a month to more than $9000, and transparency would be really helpful.

There is already a new level of transparency, point out Chester Davis Jr, president and chief executive officer of GPhA, particularly when you look at the scrutiny some companies have come under after the controversy that they have been increasing prices of drugs they purchased and did not develop.

4. Access to drugs does not have to be absolute.

While access to care and to drugs has become an issue of note, Block pointed out that she does not think patients need to have access to every single drug available. Instead, she wants to see the field move in a way that balances affordability with access, which might mean giving a little on the access side.

Boutin agreed, adding that the industry needs to move away from treating people as the average and instead build a different system that provides the right options for the right person.

“[Patients] don’t want access to everything,” he said. “They want access to what works for them.”

Andrea Grande, RPh, vice president and eastern region pharmacy lead for Aon Hewitt, echoed that sentiment in her panel discussion and noted that there are opportunities around utilization management, such as formulary designs and narrow networks, that can be used to balance the rising cost of healthcare while still providing appropriate access.

“This is a constant balance of cost and assuring that the right member get the right drug and the right amount,” she said.

5. Patients want national regulations and legislations to curb the cost of drugs.

Block actually took time to draft a bill that was passed, but she said not every person under the age of 65 and disabled is going to feel good enough or have the wherewithal to be able to do the same. And she is not the only one who wants to see more regulations and legislations.

Bianca DiJulio, associate director for the Public Opinion and Survey Research Program at the Henry J. Kaiser Family Foundation, pointed to a recent Kaiser poll that found respondents, regardless of party affiliation, wanted the president and Congress to make sure that high-cost drugs were available for people with chronic conditions. The second thing they wanted was for the government to be able to take action to lower prescription drug prices.

Debra Whitman, PhD, chief public policy officer at AARP was more frank. “People want to throw the book at this problem,” she said. “They are frustrated that they don’t have the capacity as individuals to negotiate.”