The Alliance

The Weekly Dose | 04.05.19

April 5, 2019 12:19 pm

According to data from SSR Health, net prices for U.S. branded drugs fell 5.1 percent between the third quarter of 2017 and the third quarter of 2018. Why don’t more Americans feel the effects of these drug price declines? Because savings from manufacturer rebates aren’t being passed on to them as they should.


The Senate Finance Committee will turn its attention next week to insurers and pharmacy benefit managers (PBMs) and their role in the pharmaceutical supply chain. We know that these two entities have pocketed at least $89 billion in drug-manufacturer rebates that should have gone to patients. What we don’t know if that’s the full scale of their “savings,” however, because they aren’t required to disclose this information.


Have questions about drug manufacturer rebates and PBMs? Email us. We look forward to working with you.



Patrick O’Connor – Executive Director

Rosemarie Calabro Tully – Communications Director



According to Dr. @ludybird15, the International Pricing Index Model will “unfortunately do more harm than good.” Why are oncologists concerned about the proposed #IPI model and how it'll compromise care for #cancer #patients? Read in @MorningConsult: Click here to RT.

Did you know that as a share of net spending on retail #PrescriptionDrug coverage, #patient payments declined from 34.5% of total spending in 2012 to 30.4% in 2016? Learn more facts from the @pewtrusts #DrugPricing report here: Click here to RT.

Patients with #SickleCell disease — and thousands of other illnesses — are waiting for effective treatments. Yet many of the proposals floated to curb prescription drug costs could extend this wait. Via @GBT_news: Click here to RT.

Thread here:



Most Americans Find It “Easy” To Pay For Prescription Medications. The Biotechnology Innovation Organization (BIO) has released a poll that explores Americans’ views regarding drug prices and health insurance costs. BIO’s findings reflect other surveys we’ve featured on this blog. Read the full blog post here.

In case you missed them, here are some other recent posts on the APMI blog:

- A Look At Recent Polling

- Drug-Pricing Proposals Should Worry Patients Looking for a Cure

- The Cost of Insurer-PBM Consolidation



Price Controls Will Result In Sickle Cell Patients Waiting Longer For A Cure. In The San Diego Union-Tribune, Dr. Ted Love, president and chief executive officer of Global Blood Therapeutics, explains how policies being considered in Washington could “extend” the wait for a cure for sickle cell and other diseases.

Denying Cancer Care To The Elderly? At Morning Consult, Patricia Goldsmith CEO of CancerCare, explains how “cost-savings schemes that discount the value” of certain treatments and cures harm patients with cancer, the elderly and the disabled. Goldsmith concludes, “We are outraged that patients’ access to cancer treatments is being denied because insurance company bean counters are determining that some people’s lives are not valuable enough to save.”

Former FTC Official: PBMs Have Market Incentive To “Seek Higher Prices.” At Morning Consult, David Balto, former policy director of the Federal Trade Commission’s Bureau of Competition, explains how pharmacy benefit consolidation leads to higher drug prices. He notes: “[T]hree firms control 80 percent of the market, allowing them to exploit consumers by reducing choice and increasing cost. The system is plagued by conflicts of interest. Because PBMs profit off rebates and fees that are based on a product’s price, they have strong incentives to seek higher prices.”

Former FDA Commissioner: Ending Price Controls Would Spur Innovation. According to former Food and Drug Administration Commissioner Peter Pitts, “If we axed price controls now, by 2030 we’d see an additional 13 drugs developed each year.”

Insurers Refusing To Pay For Anti-Rejection Drugs. In a truly heartbreaking story, The New York Times reports: “Patients who were not on Medicare at the time of their transplants are required to get their anti-rejection drugs through Medicare’s drug program, Part D, which is handled through commercial insurers. Those insurers refuse to pay for many anti-rejection drugs, on the grounds that they have not been approved for certain transplant patients. Payment is required by Medicare only if the drug has F.D.A. approval for a specific organ transplant, or this use is cited in one of two drug compendia that Medicare approves.”

Innovation Nation: Exploring New Treatments For Cancer. An article in The Scientist explains how pharmaceutical companies and academic researchers are working together to find a way to use “small molecules that could bind to the three-dimensional structure of misbehaving RNAs” to “prevent their translation into problematic proteins or, if they are noncoding, block their cancer-promoting function within the cell.”



Axios’ Caitlin Owens, explaining how the drug pricing debate in Washington is focused on the past, not the future:

“Medical innovation is already hurtling toward a new era of highly specialized drugs — some are even tailor-made for each individual patient. They may be more effective than anything we’ve seen before, and also more expensive. But the drug-pricing debate is more focused on decades-old parts of the system.”


Writing in the Baltimore Sun, Stephen Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America, explains how government price controls will harm innovation:

“We are living in a new era of medicine, benefiting from breakthrough treatments that would have been considered science fiction just five years ago. And the same biopharmaceutical researchers developing these remarkable innovations also know their efforts aren’t nearly as meaningful if they’re too expensive for the patients whose lives depend on them. Government price limits sound good on paper. It’s an easy political talking point. But we won’t truly help patients unless we first properly diagnose the problem they face. Today’s system forces patients to bear far too much of the burden for a medicine’s cost.”



April 9, 2019, and 10:15 a.m.: Senate Finance Committee hearing

Location: 215 Dirksen Senate Office Building

Topic: Drug Pricing in America: A Prescription for Change, Part III.


Steve Miller, Vice President And Chief Clinical Officer, Cigna Corporation

Derica Rice, Executive Vice President And President, CVS Health and CVS Caremark

William Fleming, Segment President, Healthcare Services, Humana Inc.

John Prince, Chief Executive Officer, OptumRx

Mike Kolar, JD, Interim President & CEO, Senior Vice President And General Counsel, Prime Therapeutics LLC

Contact: 202-224-4515



April 9, 2019, time TBD: House Ways and Means Committee mark-up

Location: 1100 Longworth House Office Building

Topic: Drug-pricing proposals


The SPIKE Act of 2019

R. 2604, The Samples Act

And others to be announced

Contact: 202-225-3625



April 10, 2019, 10:30 a.m.: House Energy and Commerce Oversight and Investigations Subcommittee hearing

Location: 2322 Rayburn House Office Building

Topic: Priced Out of a Lifesaving Drug: Getting Answers on the Rising Cost of Insulin

Agenda: Not available

Contact: 202-225-2927