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Building A Better Health Care System

As health insurance companies increasingly shift health care costs onto patients through high deductibles and coinsurance, more than one third of insured Americans report spending more in out-of-pocket costs than they could afford in the last month. That’s not how insurance is supposed to work.

Many patients may not know it, but there are tens of billions of dollars in rebates and discounts on medicines that are given to insurance companies and other middlemen. Too often these rebates and discounts don’t get to patients who need them. As a result, some patients pay more for medicines than their insurance company pays.

Unlike government price setting, which threatens Americans’ access to crucial, breakthrough medicines, we should make sure the rebates and discounts insurers receive get passed on to patients at the pharmacy counter – not pocketed by the insurance companies, hospitals and middlemen.

Let’s work together to make sure medicines are more affordable and accessible for patients in need.

Making Medicines More Affordable

Every reform must pass a simple test: does it benefit the patient and protect future innovation? Temporary fixes based on political rhetoric are destabilizing and counterproductive – only sustainable, patient-centered solutions will help those who need it the most. We propose policies to make medicines more affordable by:

Making Insurance Work

Making insurance work like insurance by covering more medicines from day one, making out-of-pocket costs more predictable, ensuring cost-sharing assistance applies to deductibles and sharing negotiated savings with patients at the pharmacy counter.

Learn more about insurance coverage and the role of pharmacy benefit managers.

Modernizing Medicare

Modernizing how Medicare covers and pays for medicines, including making sure the savings negotiated with health plans are passed to patients. It also includes implementing a market-based adjustment in Part B that would allow the government and seniors to benefit from more of the savings already negotiated in the commercial market, which could save some seniors hundreds – if not thousands – of dollars each year.

Protecting the Safety Net

Protecting the safety net by maintaining coverage of medicines for vulnerable patients served by Medicaid and driving greater oversight and transparency of the 340B program to ensure that hospitals and other entities are using the discounts manufacturers provide to serve needy patients, not siphoning resources away from patients.

Fostering Competition

Ending perverse incentives by tying the fees pharmaceutical supply chain middlemen charge to the services they provide, not the list price of a medicine, and fostering the competitive market for medicines while also providing needed incentives for continued biopharmaceutical innovation.

Tell Washington to Hold Middlemen Accountable

Fulfilling the Commitment

Fulfilling the biopharmaceutical industry’s commitment to help end the pandemic by expanding collaboration and manufacturing capacity and ensuring affordability and access to COVID-19 vaccines andtherapeutics.

Enhancing Supply Chain

Enhancing globally diverse biopharmaceutical manufacturing supply chains by fostering collaboration and advancing our R&D and manufacturing infrastructure.

Investing in Preparedness

Investing in pandemic preparedness and planning by creating a robust, long-term national preparedness strategy, such as modernized data and reporting infrastructure and a fully developed vision for the Strategic National Stockpile.

Thwarting Rising Threats

Ensuring a sustainable pipeline for new treatments to take on an emerging threat that’s right before our eyes – rising antimicrobial resistance.

Building a More Just, Equitable Health Care System

COVID-19 and the disproportionate impact it has had on communities of color has shown us that the time to fix inequities in our health care system is right now. Communities of color must finally receive the highest quality of care. Every patient deserves the opportunity to make rational and informed decisions about their own care. We commit to industry action and to supporting policies that will build a more just, equitable health care system, including:

Improving Clinical Trial Diversity

Improving clinical trial diversity and building an industry workforce as diverse as the communities we serve by encouraging a culture of inclusion and investments in educational pathways.

Investing in Data

Investing in rigorous data and measurement infrastructure by improving data collection and reporting that more accurately measures health disparities.

Promoting Best Practices

Promoting best practices for improving equity in health care screenings, diagnosis and treatment.

Aligning with Equity Goals

Align incentives with equity goals by supporting equity-focused quality metrics and equitable access to medicines for all communities.

We are working to deliver a more affordable and equitable health care system for all. For a summary and detailed overview of PhRMA's patient-centered agenda, click below.