Video & Highlights from “5 Slides: Bending the Rx Cost Curve”
National medical experts with ample experience with prescription drug policy joined State of Reform at our Texas “5 Slides” event on Tuesday to discuss ways to address the country’s ever-increasing cost of prescription drugs.
In this conversation, Representative Michael Burgess, MD, member of the House Energy and Commerce Committee, Wayne Winegarden, senior fellow and research director for the Center for Medical Economics and Innovation at the Pacific Research Institute and Annette Guarisco Fildes, president and CEO of the ERISA Industry Committee discussed biosimilars, policy solutions and more.
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Burgess centered his remarks around the cost of prescription drugs under Medicaid programs. He referenced the 21st Century Cures Act of 2016, which secured funding to expedite research for new medical treatments. Burgess noted, however, that this legislation didn’t go far enough — it didn’t offer a solution to the actual high cost of novel treatments.
Using the example of sickle cell disease, Burgess said newly discovered treatments are often very expensive, meaning breakthrough medical solutions are often underutilized. He explained that an FDA-approved therapy for sickle cell disease was recently discovered. With this therapy, providers can tame and utilize the AIDS virus in a single, effective treatment. However, the cost of providing this treatment is so high that it hasn’t been taken advantage of.
He said legislation like the Lower Costs, More Cures Act — which failed to become law in 2019 — would provide a solution to this issue by prorating and extending Medicaid coverage for “groundbreaking” therapies like this.
“We’ve got to do something different from what has been done historically. Otherwise, we’re going to end up where payers, like our friends who sponsor employer, multi-state insurance plans, are not able to afford what they have been historically delivering.”
Winegarden discussed the affordability of biologics versus biosimilars. He explained that biologics are much more complicated to create than chemically derived drugs because of the variations that naturally occur in biology. Biosimilars are the “significantly cheaper,” generic version of biologics.
He called the prescription drug affordability crisis a “tailored crisis” that is largely the result of the high cost of biologics. He disputed current discourse around biologics, which he said has suggested that these drugs have a natural monopoly and thus prevent competition.
“Biosimilars not only can work, but it is now beginning to work. We need to continue with policy reforms to make the market stronger.”
While Winegarden explained that biosimilars currently are much more prevalent in Europe’s prescription drug market, he said they are starting to make their way into the U.S. market, cutting down prices and promoting affordability.
Fildes also spoke about the savings associated with an increased use of biosimilars. She referred to a study that took data from 13 of ERISA’s member companies, representing every industry sector, and worked with the Johns Hopkins School of Public Health to evaluate drug spend and medical plan spend for biologics.
The analysis looked at infliximab and filgrastim, two biologics for which there has already been a biosimilar for at least a year, and examined what the savings would have been if the biosimilars of these drugs had been used 100% of the time instead of the biologics. The results showed that infliximab users would pay an average of 12% less on their medications, and filgrastim would pay 45% less.
“On average, these thirteen employers, for just these two drugs, would have saved almost $5 million a year. That was back in 2018 — imagine what the savings would be now, when more and more people are using the biosimilar.”
Fildes provided a list of legislation aimed at increasing biosimilar use, including the “Stopping the Pharmaceutical Industry from Keeping Drugs Expensive Act” (SPIKE) of 2019 and the recent “Advancing Education on Biosimilars Act of 2021.”