One Size Doesn't Fit All

Complex Solutions For Patients

12.11.13 | By

Over the weekend, the Washington Post ran a story about the price of prescription medicines offered through the Medicare Part B program, a benefit that provides coverage for outpatient administered medicines. Often times, patients in Part B face very serious and complex conditions, including cancer, end-stage renal disease, cerebal palsy, immune deficiency disease, and multiple sclerosis. In an effort to reduce Medicare spending, the author proposes implementing price controls in Part B without mention of potential and significant repercussions that such a move could have on patients’ access to life-saving medicines.

The author points to the European health system, which has government price controls, as a positive example of how patients pay less for their medicines, but doesn’t acknowledge the subtle, but very important fact that patients in the U.S.  experience much better health outcomes than European patients, partly because they have access to medicines that patients in these other countries may be restricted from. In fact, the only way that Europe is able to achieve savings is through narrower formularies, thus limiting patients’ access to a diverse array of prescription medicines. A Tufts study found that between 2000 and 2005, 73 percent of medicines were launched in the U.S. before becoming available in Europe, and this is largely attributable to the lack of price controls in the U.S. It’s also important to note that the five year survival rate for all cancers is 40 percent higher in the U.S. than in Europe for men, and 13 percent higher in the U.S. for women.

The article also hit upon least costly alternative policies, like those found in Europe, which allow the government to make clinical judgments about treatments for patients without recognizing the basic fact that every patient responds differently to a medicine. The cheapest option might not always be the best option for patients and it’s important to recognize this fact. To date, there are more than 5,000 medicines in development and implementing similar price control policies like those found in Europe could discourage continued medical progress.

Part B is a program that relies on a competitive, market-based system to determine reimbursement rates, and making changes in the form of price controls could mean serious health consequences for patients who rely on these important medicines.

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