Americans with digestive diseases need affordable access to drugs and biologics. Increasing out-of-pocket expenses limit patient access. Improving affordability requires a multi-faceted approach from across the health care system, including health insurers, drug and biologic manufacturers, and pharmacy benefit managers. As these stakeholders and policymakers work to improve the affordability of drugs and biologics in the U.S., AGA urges focus on five key principles:
1. DECREASE OUT-OF-POCKET EXPENSES FOR PATIENTS.
High out-of-pocket expenses limit access to necessary therapies for people with digestive diseases. High out-of-pocket costs also contribute to noncompliance, which can result in complications and more costly care such as emergency room visits, hospitalizations, and surgery.
2. MAINTAIN REASONABLE INCENTIVES FOR INNOVATION.
Improving access to digestive disease therapies should not impede the innovation and development of better therapies. Although AGA advocates for reduced out-of-pocket costs for those with digestive diseases, solutions should not de-incentivize future innovation.
3. INCREASE COST TRANSPARENCY.
People with digestive diseases should be able to easily and quickly identify how much they will pay out-of-pocket before receiving care. As more and more costs are shifted to patients, there is greater need for increased transparency with respect to health care services, including the cost of drugs and biologics.
4. PROMOTE SHARED DECISION-MAKING.
Informed patients can participate effectively in the medical decision-making process by asking questions and expressing values and opinions about their conditions and treatment options.
Shared decision-making can potentially reduce costs when cost information is included in the decision-making process.
5. BOOST COMPETITION.
Increased competition is associated with lower drug and biologic prices, with the largest decreases occurring when there are multiple generic competitors. Although the cost reduction effect of multiple biosimilar and interchangeable products is unknown, increased competition in this market is expected to have a similar impact.