WASHINGTON, DC (February 28, 2019) – Today’s report from Avalere is further evidence that America’s patients are needlessly spending too much out of pocket for affordable generics. Since 2015, seniors have paid nearly $22 billion in additional out-of-pocket costs for their prescription drugs in Medicare.
The 10th edition of AAM’s annual generic drug savings and access report, which was released last month, is full of important data for policymakers as well as industry leaders. The report provides detailed information on savings by state, payer type, treatment area, and other factors, as well as the state of the biosimilars market. Here are 10 noteworthy takeaways from the publication.
More than 9 out of 10 generic drug prescriptions are filled for $20 or less. Everybody who takes medicine to get or stay healthy can appreciate these savings, which allow patients and families to spend their money on other things that matters to them. Those savings, however, are now in jeopardy, thanks to a combination of factors. Here’s what you need to know.
As federal and state policymakers grapple with how to lower prescription drug prices, they should work to ensure that patients, particularly seniors, have greater access to and realize the full benefit of lower-priced generic drugs.
Increasingly, Medicare Part D plans are putting generic drugs into higher formulary tiers to compensate for escalating brand-name drug prices.
AAM Statement on Generic Drugs in Medicare Part D. Trends in Tier Structure and Placement, Avalere Health, May 22, 2018:
“In 2015, patients spent more than $6 billion in additional out-of-pocket costs on generic drugs compared to 2011. These increased out-of-pocket expenses on low-cost generics are being used by the plans to mask increases in branded drug prices.”
Avalere Health study funded by Association for Accessible Medicines.
The Biosimilars Council Opposes Efforts to Prohibit Biosimilars From Receiving Pass-Through Status in the Medicare Part B Program
Despite the importance of biosimilars to reducing the cost of medicine, policymakers recently included a provision in a proposed bill that would have prohibited biosimilars from receiving pass-through status in Medicare Part B. While this provision was ultimately removed from the final legislation, the Biosimilars Council is concerned that it continues to be proffered by certain brand biologic manufacturers as a means to stifle biosimilar competition.
Increasing Patient Access to Biosimilars in Medicare Part D
Congress should amend the Part D coverage gap discount program to classify biosimilars as “applicable drugs” in the Coverage Gap Discount Program. This change would allow biosimilar manufacturers to pay the 50 percent discounts paid by their brand competitors, and participate on a level playing field to compete for placement on the Part D plan’s formulary. It would reduce both patient out-of-pocket costs and Part D program spending.