As the public focus on new, innovative diabetes and anti-obesity medicines has increased, so have attempts by insurers and others to distort the facts about the potential costs to the health care system.
Critics repeat same, misleading narrative on potential “costs” of new medicines.
As the public focus on new, innovative diabetes and anti-obesity medicines has increased, so have attempts by insurers and others to distort the facts about the potential costs to the health care system.
We shouldn’t be surprised.
Every time new groundbreaking medicines are approved insurance companies claim these life-changing innovations will bankrupt the health care system.
Here’s what it looks like: overestimate the potential costs of providing access to new transformational medicines, ignore that payers leverage competition to extract significant discounts that lower the costs of brand medicines, undervalue the savings from treatment and prevention, and overlook that medicines are the only part of the health care system where prices go down over time.
Insurers use these scare tactics as an excuse to put in place unnecessary and burdensome restrictions or to deny coverage altogether. Their answer to health care is to simply not pay for it.
Yet, as we’ve seen with life-changing treatments and cures for high cholesterol, Hepatitis C, and others, claims about the financial havoc to come have turned out to be false. In fact, we saw just the opposite because we have a competitive market that results in significant rebates and discounts, and eventually low-cost generics and biosimilars.
What was said about innovative cholesterol-lowering medicines, called PCSK9 inhibitors:
What was said about groundbreaking new Hepatitis C cures:
These are just a few examples, but looking back, we consistently see this story repeat. A study from the Partnership for Health Analytics (PHAR) looking at 25 predictions of the cost of new medicines over a five-year window showed almost half of those predictions were off by more than $1 billion.
This rhetoric isn’t just misleading; it leads to real access barriers and restrictions for patients who rely on medicines.
In the case of anti-obesity medicines, data shows discounts and rebates already lower the net costs of treatments by as much as 79%. A recent analysis that looks at net spending shows spending is far less than recent reports that overlook these substantial negotiations.
We shouldn't give insurance companies another free pass to find more reasons to discriminate against people who need medicines. Instead, our focus should be on incentivizing the development of and expanding access to new innovative medicines that treat and prevent diseases.
