Transparency in Drug Pricing Key to Reducing Patient Burden

This year, there's potential for the Affordable Care Act (ACA) to be repealed with the incoming second Trump administration. In part 2 of our interview, cochair of our recent Institute for Value-Based Medicine^® event hosted with NYU Langone Health, Oscar B. Lahoud, MD, speaks on his hoped-for top health care priorities under the incoming administration.

Lahoud is clinical associate professor at NYU School of Medicine; section chief, Hematology, NYU Langone Health in Brooklyn; and director for strategy and network operations, Hematology/Oncology, the Perlmutter Cancer Center.

You can revisit part 1 of our interview here.

This transcript has been lightly edited for clarity.

Transcript

What you would like to see be top health care priorities for the new administration?

I think one of the greatest impacts that we've had for our patients, and perhaps that wasn't discussed enough in the news, is people have been talking about the ACA—which is great and it has helped a lot of people, but perhaps not the hospitals as much. But one thing that I've noted has had phenomenal impact on my patients is the maximum out-of-pocket expense in co-pay.

Cancer drugs are very expensive. They average about $20,000 a month. So if you only have Medicare without any prescription assistance, or secondary insurance, you're left with 20% of that, which is outrageous—especially when many cancers require combinations of some of these drugs. So you end up at $40,000, $50,000 a month. Even if 80% of that is covered, at $10,000 a month in co-pay, it's just unrealistic for anybody.

And so now that President Biden had it capped for 2024 at $3300 for the year—the out-of-pocket maximum for prescription drugs—and next year at $2000, I really hope that this stays on. If anything, I'm hoping that it will improve because that truly impacts patients on a day-to-day basis (“I can't pay for my drug!”). I treat cancer, but I can only imagine those with chronic conditions, like diabetes and others, who would struggle even more.

We're still in the unknown in terms of other than the repealing of the Affordable Care Act that one side discussed. The hope is that if that were to happen, they would replace it with something different that would sort of carry the same function and perhaps something better. But who knows?

In terms of drug pricing, PBMs [pharmacy benefit managers] were sort of described as probably the key target to first have more transparency in terms of why the prices are what they are, and perhaps negotiation for Medicare and insurance programs to have to pay less for the drugs. And so once there's more transparency in that, hopefully we'll see some upheaval in movements to lower drug prices in general. I'm of an optimistic nature in general, but I really think that we're going to start getting some improvement.

With some of those pharmaceutical companies backing people in the Senate and Congress, some of those tend to abstain from truly speaking up and declaring what they believe, because I cannot believe that any senator is not appalled by the prices the US is marketing drugs when across the border in Canada, they're a fraction of the price.