Why does Humira cost over 5x more in the U.S. than it does in other developed countries?
Industry experts cite costs associated with research & development, lack of competition, direct-to-consumer advertising, lack of transparency, our free-pricing system, and the ban on federal negotiation of drug prices.
What these same industry experts don’t tell you is how big pharma games the system. Drug manufacturers use widespread strategies to violate anti-trust laws to limit competition, extend patents, maintain exclusivity, and limit distribution.
As if all of this wasn’t enough, every year the FDA approves a long list of complex drugs designed to cure and treat advanced disease states. These new-to-market wonder drugs are typically very expensive and are protected by lengthy patents that prohibit generic substitutions. As of 2017, the FDA identified some 150 drugs that could have generic competition but do not, which means that patients are paying more—much more—for drugs.
If all of this makes your head spin, you’re not alone.
Most Plan sponsors feel completely overwhelmed when faced with controlling escalating drug costs within their Plan.
What if you had an Rx Playbook, a plan with strategic solutions designed to target the current and future prescription drug cost drivers within your Plan? Well, there is, and it includes some of the following proven concepts:
Yes, design your Plan to encourage generics, when possible, to save money. According to the FDA: “All generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand-name drugs, and the generic products must meet the same exacting specifications as any brand-name product.”
Additionally, you may want to consider sourcing drugs from other tier 1 countries. According to Kaiser Family Foundation, 19 million American adults import medications to save money—that’s 8 percent of the U.S. population. Internationally sourced drugs come from the same drug manufacturers with the same FDA approvals as the prescriptions filled at your corner drug store. The only difference is that they bypass the U.S. pharmaceutical system, which drives deep savings for Plans and members.
Furthermore, drug manufacturers offer deep discounts on high-cost drugs for patients who qualify based on household income limits. Not all who apply will be eligible, but the qualification thresholds can be as high, for some drugs, as 6x the FPL, or $157K for a family of four.
We can help.
If you’re like most Plan sponsors, and prescription drug costs concern you, don’t feel trapped. A lot can be done, and the savings are there for the taking. If you have questions or would like to discuss, please contact BCF Group for more information.