Paper: Governments' and Physicians' Opposing Views on Rx Value Could Complicate Patient Care

Differing approaches to medication value may undermine patient-centered care as the Inflation Reduction Act allows officials to negotiate some Medicare Rx prices

WASHINGTON, Aug. 30, 2023 /PRNewswire/ -- Government officials and physicians don't always agree on the value of prescription drugs, a new paper from the Alliance for Patient Access explains, and the discrepancy could impact patient care when U.S. officials begin price negotiations for certain Medicare drugs as authorized by the Inflation Reduction Act.

About the Research 

To examine discrepancies in medication value, researchers asked 350 U.S. physicians to respond to a European government's assessments of certain drugs for three conditions: ulcerative colitis, psoriatic arthritis and multiple myeloma.  

The research used metrics from Germany's Federal Joint Committee, or G-BA, the centralized decision-making body in Germany's health care system. 

Key Findings 

Only 10% of U.S. physicians agreed with the G-BA's negative assessments of the innovative medications. And the overwhelming majority – 90% — said the medications had additional benefits for patients.  

The gap suggests that physicians and government agents approach the question of value differently, the paper explains. Physicians are likely to also consider real-world factors such as:  

• Unmet needs
• A medication's ability to prolong life expectancy until the next treatment is available
• The method and frequency of drug administration
• Indirect benefits, such as allowing patients or caregivers to continue working

The research echoes similar findings from 2019, when 89% of surveyed U.S. physicians disagreed with the G-BA's negative evaluation of innovative diabetes medications and 97% said the medications offered additional value for patients. 

Physicians consider the nuances of their patient's diagnosis, comorbidities, health history and lifestyle, the paper notes. Government agents take a more systemwide, population-health approach.  

Implications for Patient Care 

Establishing drug prices based solely on a government definition of value could create challenges for patients, such as: 

• Inability to access new treatment if insurance plans make certain drugs harder to access.
• Less personalized care as physicians feel compelled to make treatment decisions based primarily on cost.
• More frequent non-medical switching, where health plans drive stable patients from effective treatment to a more profitable alternative, triggering side effects and re-emerging symptoms.
• Less research and medical innovation, with experts predicting that 135 fewer new drugs will come to market over the next two decades.

READ: At What Price? Medication Value, Patient Care & the Inflation Reduction Act

The Alliance for Patient Access is a national network of policy-minded health care providers advocating for patient-centered care.

SOURCE Alliance for Patient Access