PhRMApedia Resources

PhRMA Fact Sheets

Access to Asthma Medicines in Exchanges

Asthma is a common, chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma, including about 7 million children.

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Access to Combination Therapies in Exchanges
Combination therapies are medications that contain two or more pharmaceutical ingredients in a single dosage form (e.g., tablet, capsule) for the treatment of a condition. Oftentimes, patients living with chronic conditions—such as HIV and diabetes—rely on combination therapies because they reduce the number of medications or dosages a patient must take, which can increase adherence and clinical efficacy. Read More
Access to Diabetes Medicines in Exchanges

The annual number of patients who were newly diagnosed with diabetes has tripled in the past twenty years, and type 2 diabetes accounts for 95% of diagnosed diabetes in adults. As many previously uninsured people enroll in exchange coverage and access primary care, the diagnosed cases of diabetes may increase further. Medicines are a key component of managing diabetes. Most patients take oral medicines to stabilize blood sugar levels, but over time, many patients also add insulin to their treatment regimens.

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Access to HIV/AIDS Medicines in Exchanges

Prescription medicines are a crucial component of treatment for HIV/AIDS. Multidrug regimens have substantially reduced HIV progression to AIDS, opportunistic infections, hospitalizations, and deaths. Even so, early ART regimens often required patients to ingest several large pills multiple times per day. New formulations, such as single-tablet regimens, reduced the pill burden dramatically, improving adherence and slowing disease progression.

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Access to Mental Health Medicines in Exchanges

For many patients with mental health conditions, prescription medicines are a key component of treatment. Antidepressants are highly effective for a range of mental health conditions, with several classes of medicines available. Clinicians generally base selections on highly individualized factors, including the patient’s specific depression symptoms; a prior response to specific antidepressants (if applicable); and side effects. Other common medicines for treating mental health conditions include antipsychotics and bipolar agents.

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Access to Multiple Sclerosis Medicines in Exchanges

Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system that is a leading cause of disability in young adults. MS disrupts the ability of parts of the nervous system to communicate. MS can take several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms). Between attacks, symptoms may go away completely; however, permanent neurological problems often occur, especially as the disease advances.

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Access to Oncology Medicines in Exchanges

Chemotherapy and other medicines are central to the treatment of nearly all forms of cancer. Chemotherapy has evolved tremendously as researchers have come to better understand the genetic underpinnings of cancer. New, targeted therapies attack aspects of cancer cells that distinguish them from normal, healthy cells and are often designed to treat a handful of specific cancer types. Targeted therapies cause less damage to non-cancer cells; thus these medicines often produce less severe side effects than other kinds of chemotherapy.

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Access to Rheumatoid Arthritis Medicines in Exchanges

Rheumatoid Arthritis (RA) is an autoimmune disease that causes chronic joint inflammation and painful swelling that may result in long-term damage and disability. In addition to causing joint problems, RA sometimes can affect other organs of the body—such as the skin, eyes, lungs, and blood vessels. Immunosuppressant medicines are an essential component of RA treatment; these medicines help to reduce inflammation and prevent joint damage.

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Barriers Created by UK NICE

The approach used in the United Kingdom, and other European countries, to make coverage or reimbursement decisions for new tests and treatments based on a centralized value assessment is sometimes pointed to as a model for the U.S. However, new analysis illustrates how the use of a cost‐effectiveness standard by the UK’s National Institute for Health Care Excellence (NICE) as the basis for coverage decisions often creates barriers to patient access to beneficial new treatment options.

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Global Variability in HTA Decisions Poses Challenges for Innovative Biopharmaceutical Research and Development

In recent years, technology appraisals and reimbursement recommendations from established health technology assessment (HTA) organizations around the globe are taking on an increasingly prominent role in cost-containment and seem to have become more restrictive in nature. In order for important new health technologies to reach patients, innovative research companies must achieve market access not only through stringent regulatory processes, but also by gaining reimbursement approval from many countries around the world.

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Key Facts About Prescription Medicine Costs

Government and independent data show that spending on prescription medicines has grown at historically low rates for a sustained period. Future spending growth is expected to remain low and government agencies have repeatedly lowered their cost projections. For example, the Congressional Budget Office (CBO) has reduced its 10-year forecast of Part D spending by over $100 billion in each of the past three years, and in January 2012 the CMS Office of the Actuary (OACT) reduced its prior year’s estimate of drug spending by more than half.

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Measuring Generic Efficiency in Part D

Generic efficiency rate is a measurement of the total number of prescriptions filled as a generic for products with a direct generic substitute within a therapeutic area of interest. Regardless of subsidy status or therapeutic area, patients almost always fill a generic molecule when it is available (greater than 94% across all therapeutic areas of interest). There is little difference in generic efficiency between Low Income Subsidy and Non-Low Income Subsidy Part D patients.

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New Medicines Yield Significant Progress against Serious Diseases

The U.S. health care system faces great challenges which must be addressed. At the same time, outcomes continue to improve, with the use of new medicines playing a large role in achieving better results. This fact sheet provides examples for a few major disease areas.

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NICE Limits Reimbursement for Oncology Products beyond EMA Product Labeling

In recent years, technology appraisals and reimbursement recommendations from established health technology assessment (HTA) organizations around the globe are taking on an increasingly prominent role in cost-containment and seem to have become more restrictive in nature. As HTAs have become a prominent element of health care decision-making in many countries, attention is turning to whether they assess outcomes and measures that are most meaningful to patients and their physicians.

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Out-of-Pocket Costs on Health Insurance Exchanges

Health Insurance Exchanges, also known as marketplaces, were established as part of the Affordable Care Act (ACA) to expand access to quality health care and help control the nation’s health care spending. However, recent research finds that coverage offered through the Exchanges threatens to have a negative impact on patients’ health due to limits on prescription drug coverage and increased out-of-pocket costs through higher deductibles and co-pays. 

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