Affordability: Who's Responsible?

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Pharmaceutical Commerce, Pharmaceutical Commerce - October 2023, Volume 18, Issue 5

The debate continues as to how government payers should weigh covering healthcare needs versus other budget items.

Advances in technology, aging of populations, and unhealthy lifestyles have contributed to rapidly rising healthcare costs. Healthcare affordability is a large issue for governments, insurers, employers, and patients today, but there is concern that it could become a much bigger issue tomorrow. How do we deal with that?

Cardiovascular diseases and cancer have a large impact on patient lives. New technological solutions have helped to alleviate the humanistic burden but have also increased the healthcare bill. Many unmet needs remain in almost all therapy areas. Technical advances will likely produce new medical and pharmaceutical solutions that will come with tough budget choices. How should government payers choose between covering increasing healthcare necessities and needs for the other two largest US budget items, social security and defense? Let’s consider two disease areas with different challenges.

Alzheimer's disease

Without any effective interventions, Alzheimer’s disease alone, it's been reported, can bankrupt our healthcare system due to long-term care needs. Recently approved Leqembi, made by Eisai and Biogen, showed modest effectiveness in terms of delay of onset of cognitive symptoms. The drug offers hope that the amyloid plaque avoidance strategy may ultimately lead to improvements and avoidance of the debilitating effects of the disease. High treatment costs will add to the healthcare bill, but it will be offset by savings due to avoidance of long-term care needs. Any effective and safe drug treatment will attract a high volume of patients that need preventative treatment for many years. With the current generation of drugs, one could make the argument that improvement of patient and caretaker lives and system savings will be limited. However, it is critical to continue investments to hopefully at one time cure Alzheimer’s disease and avoid impending healthcare system bankruptcy.

Obesity

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Recent evidence of the weight loss and cardiovascular health benefits of Ozempic and Wegovy have garnered plenty of social media attention and hype. With over one third of the US population being obese and an additional one third overweight, according to the NIH, a question arises on what the appropriate use of these drugs is. How should we incorporate weight loss drugs in our lifestyles? There is a broad spectrum of need across the population, ranging from morbidly obese patients that are in need of new solutions to otherwise healthy individuals to maintain a nourishing lifestyle. Ballooning sales of these drugs poses some
fundamental questions for our society and the industry. Will we get to a point where most of the population takes drugs to control weight for the rest of their lives, and should we work harder to encourage maintaining a healthy food chain and lifestyle?

Insurance coverage

Which healthcare innovations should be covered by government and private health insurance? Should health insurance premiums vary depending on body mass index, fitness, or even gene map? That raises many ethical and fairness questions, particularly since some of these factors are beyond our individual control. As the government shoulders a large proportion of healthcare costs, how should it choose between covering increasing healthcare necessities and needs in the other two largest US budget items, social security and defense?

Biopharma industry's role

Narrowly focusing on drugs as a solution to weight problems opens up concern as to what the role of weight loss drugs should be, for which populations, and how it fits with tighter control of our food chain, personal lifestyle responsibilities, and interventions such as bariatric surgery. This question can only be solved by a tighter collaboration between the pharma sector, medical community, FDA, and the health insurance industry.

About the Author

Ed Schoonveld is a value and access consultant, and author of The Price of Global Health.