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President and Co-Founder, CMPI
It’s likely that 2013 will be the year remembered as the year of the ObamaCare website fiasco. It’s a story tailor-made for the media. But the real stories lie elsewhere.
2013 should be commemorated as the year that America began to celebrate the real debut of personalized medicine. New medicines for cancers and orphan diseases were approved by the FDA using a more progressive view of the risk/benefit equation. And, for the first time, the voice of the patient really made a difference in the agency’s calculations. 2013 will be seen as the year when the FDA began to think about a greater dimensionality of benefits via functional endpoints.
2013 may also be viewed by future generations of healthcare pharmacenti as the year when “blockbuster” thinking was replaced with a focus on patient outcomes. The implications for R&D investment in new molecules as well as companion diagnostics make 2013 the year when we finally take to heart both the philosophical and business proposition that getting the right medicine to the right patient in the right dose at the right time is the best way to embrace a patient-centric care paradigm that is also cost-efficient.
But 2013 may also be viewed as the year when Uncle Sam got into the business of telling physicians (and nurse prescribers) how to practice medicine. This is, after all, the year that “government detailing” (aka, “academic detailing” or “counter-detailing”) hit the streets via our tax dollars and minus any federal oversight. It’s an issue that’s been flying under the radar screen – and that makes it more insidious and twice as dangerous.
What will define 2014? There are many possibilities. Certainly near the top of the list is the march towards American biosimilars. 2014 will be the year when the FDA decides on the INN issue. It’s the rare opportunity when we can learn from the mistakes other nations have made. I predict that the FDA will do the right thing and insist that FOBs carry a sim prefix or some such specific identifier. You cannot create comfort among prescribers and patients with therapeutic ambiguity.
Will 2014 be the year when healthcare communicators and pharmacovigilance trackers decide to embrace social media? Will 2014 be the year of more creative and aggressive use of adaptive clinical trials? Will 2014 be a year of developmental and regulatory success for new antibiotics? Only time will tell.
Let’s hope that 2014 builds upon the success of 2013, learns from it’s failures and surprises us in exciting ways that we didn’t even expect.
Executive Director, CAHC
From my perspective, the biggest accomplishment in 2013 – a slowdown in health spending – might also be the biggest challenge as new coverage under the Affordable Care Act is implemented in January. Much ballyhooed by analysts and decision makers, per capita health spending grew by 3 percent between 2009 and 2011, a decrease from the 5.9 percent annual rate of growth during the past 10 years. In October this year, spending growth was 4.1 percent, up from the slowdown, but still below average.
Lower health spending growth can translate into lower consumer costs, higher economic growth, lower budget deficits and a more stable labor market that produces more jobs and higher earnings.
But part of the slow-down was due to lower incomes and lost coverage from the recession. Part of it was from fewer new technologies, such as devices and new drugs. Fully 20 percent of the slowdown, however, is attributable to lower consumer demand as employers and others shift costs to consumers via higher deductibles and increased cost sharing in order to keep premiums affordable.
Why should we care? We are seeing a similar benefit trend in new plans available via the health exchanges. Plans seeking to attract new enrollees are offering reasonable premiums. Because of the ACA’s mandates, however, health plans have fewer levers to keep premiums low. Benefit design is an emerging strategy to both attract new enrollees and hold down costs via higher consumer out of pocket costs.
An analysis of 84 plans in the 15 largest markets by Avalere found that in exchange for lower premiums, insurers are offering plans with higher cost sharing, including deductibles, cost sharing, spate drug deductibles and coinsurance on the top tiers of formularies. The vast majority of exchange plans require copayments (fixed dollar cost sharing) and coinsurance (percentage of drug costs). The average coinsurance applied at higher end of the formularies is 33 percent. If a drug at that tier costs $10,000, cost sharing would total $3,300. This not inconsequential sum points to the opportunity and benefit: more can be covered under new plans, but many may not be able to afford the benefits provided by the coverage.
While these arrangements will help keep premiums lower than they otherwise would be, access to unaffordable coverage is tantamount to no coverage. This is important because if sicker, older people enroll in 2014, premiums will be more expensive in 2015. Cost sharing will likely be more expensive as well. These two trends may usher in adverse selection and a death spiral that could destabilize coverage for those who need it most, a situation all should want to avoid.
Congress and the Administration can take steps to provide more flexibility to employers, consumers and plans to keep costs low while protecting access to life saving medications. Changes to community and age rating, eliminating industry taxes and increased price and quality transparency are four needed changes. We have offered more elsewhere.
We should applaud lower health spending growth because it produces tangible benefits, but we must also be vigilant that it improves value for consumers and employers. If that happens, 2013’s slowdown would be a big accomplishment and set the stage for more progress in 2014.
Larry Hausner, MBA
CEO, American Diabetes Association
The rocky rollout of the Affordable Care Act’s health insurance marketplaces has been frustrating and disheartening at times, but you cannot deny what an unprecedented accomplishment it is that 6 million Americans have found good health coverage in 2013 through public and private insurance options made available to them because of the historic law.
For people with diabetes, these new health insurance options provide exceptional opportunities to access the care and services they require on a daily basis to effectively manage their diabetes.
Take, for example, Karmel Allison. She may be familiar to you after nearly fainting behind President Obama during a speech on the health care law at the White House in October. While most of us can’t relate to Karmel’s experience at the White House that day, for millions of people with diabetes, her struggle to find and maintain health insurance is all too real.
Karmel is like so many other people with diabetes struggling to care for their disease without breaking the bank. She was diagnosed with type 1 diabetes at the age of 9 and has remained on the same health insurance plan for nearly two decades fearful that another plan wouldn’t cover her preexisting condition. In early-October, Karmel, published a blog post entitled, “What Obamacare Feels Like To A Diabetic.” For Karmel, browsing CoveredCA.com, the state of California’s online health insurance marketplace, was a “shocking experience” when the questionnaire only asked information about her age, income and family size. She didn’t have to disclose her diabetes or any of the complications that haunt people affected by the disease.
The Affordable Care Act has given millions of Americans choices when it comes to selecting health coverage and that is an accomplishment to be proud of. The road that led us to the Affordable Care Act was not without obstacles and as we continue down this path of implementing the law, we will surely be faced with unexpected hurdles like we’ve seen over the last several months. But for the millions of people with diabetes like Karmel, 2014 brings new opportunities to prevent, treat and maybe even cure this devastating disease.
Without a doubt, the implementation of the Affordable Care Act (ACA) was the most important advancement to our country’s health care system since the introduction of Medicare. This legislation provides a lifeline to heath care coverage that was outside the grasp of many individuals. The opening of the health insurance marketplace had a rocky beginning which frustrated patients, providers, payers, and policymakers. However, by December 30, more than 2.1 million people had enrolled in private health insurance plans through new federal and state websites.
Unfortunately people are being required to buy health insurance under ACA without being provided with the necessary tools to make informed decisions. Information about qualified health plan (QHP) premiums and deductibles and plan subsidies for people who meet income requirements is available on the web. But these data points only drive people to buy the cheapest health insurance plan, not necessarily the best plan for their individual health and budget needs.
In 2014, the patient advocacy community is stepping up its efforts to fill the information gap. We are creating a unique cost calculator that will help patients estimate their annual health costs based on their age, state of residence, and individual medical service and drug usage. We have put together a website to provide a one-stop-shop of patient-focused materials created by various patient organizations that explain the health insurance marketplace and provide useful guides to finding the right plan.
The site also collects patient stories about their experience enrolling in and using QHPs. The National Health Council will be using the stories it gathers as well as data collected from a statistically-relevant survey to help policy makers understand what is working and what needs to be changed to improve the marketplace. These stories will influence the recommendations the NHC will be sending to the Administration in 2014 to enhance the patient marketplace experience.
Our hope is that in the coming months all stakeholders in the health community will unite behind the nation’s patient advocacy organizations and support this initiative to provide people with the information they need to ensure they select the right health insurance plan for them and their families.
Pharmaceutical Research and Manufacturers of America®950 F Street, NW Suite 300, Washington, DC 20004
Additional Resources: AccessBetterCoverage.org | FromHopetoCures.org | Innovation.org