Within President Obama’s budget request to Congress, he simultaneously proposes the development of drugs to treat individual patients and their personal genetic characteristics, while also expressing concern about costs for both consumers and the Medicare program.
For that reason, he has proposed that Medicare officials be able to negotiate drug prices with manufacturers.
Currently, this is against the law, but perhaps that could change. With certain types of therapies included within the president’s precision medicine initiative climbing to tens of thousands, even hundreds of thousands of dollars, usually paid out of pocket, sustainability becomes questionable. The precision medicine initiative being considered by Congress includes a $215 million proposal, which has many scientists and researchers excited. But what about consumers and insurers?
Dr. Francis S. Collins, the director of the National Institutes of Health, is concerned about drug prices, but sees promise in the future, according to The New York Times.
“Is that the path that precision medicine inexorably is going to take? I would certainly hope not,” he said.
“Long term,” Dr. Collins said, “it’s likely that this approach can reduce health care costs by providing a more effective way to treat disease in an individualized way, so that treatments are more likely to work for a subset of individuals who have a particular form of a disease or disorder.”
However, he went on, “I’d be reluctant to say that in the short term those kinds of rewards are going to occur. I’d love it if they did.”
Companies like Vertex, Amgen, Pfizer and Novartis have developed specialty drugs to treat things like cystic fibrosis and different forms of cancer — but prices can end up being $9,210 a month or even $311,000 a year, with treatment time varying. They do have patient assistance programs to provide financial help or free medicines to people who could not afford the drugs, The Times reported. But are qualifications for the programs realistic?
Dr. John D. Bennett, president of the Capital District Physicians’ Health Plan, which serves 460,000 people in upstate New York, said: “The rising cost of specialty drugs has the potential to bankrupt our health care system. What good is a miracle drug if you can’t afford it?”
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Last month, the Medicare Payment Advisory Commission told Congress that high-cost drugs pose a challenge for Medicare beneficiaries (who typically pay 25 percent to 33 percent of specialty drug costs) and the government.
If Medicare officials and drug manufacturers could potentially work together on prices, precision medicine could have more potential to make a significant difference in the lives of patients.
