The Medicare Part D switchover of 2007 is only a partial proxy for what the healthcare system will experience in the next several years
“Healthcare Exchanges’ Impact on Branded and Generic Manufacturers: the Good, Bad and Unknown” was the title of a presentation by Tracy Foster, president of Lash Group, a unit of AmerisourceBergen Consulting Services, at a summit meeting held by the firm (Oct. 7-8, Dallas). Lash Group has a particular stake in how health exchanges will play out, as it manages a wide variety of patient assistance programs, copay programs and similar market-access activities for biopharma clients.
Three key actions should be taken by both branded and generic manufacturers today, advises Foster. First, the Affordable Care Act (under which the exchanges are being organized, either at the state or federal level) will require ongoing monitoring of decisions on elements such as formulary designs and the pricing of insurance plan elements (along with deductibles, copays and co-insurance)—all of which can have an impact on patient access to medicines. Second, there will be a need for stepped-up education of both patients and prescribers on how the new insurance plans will work. “The lowest-cost Bronze plans will have higher deductibles and copays—but people throughout healthcare will need to educate themselves on these tradeoffs,” she says. Third, there will be disruptions in activities like patient assistance and copay programs (some of which are banned for today’s Medicare patients)—but that the need for such programs will remain, and federal guidance is still muddled on what will be allowed or prohibited. In an interview with Pharmaceutical Commerce, Foster noted that her company’s current book of business has not changed dramatically to date.
The biggest imponderable—and the one that will affect not just drug-prescribing patterns but the future shape of healthcare in the US—is how active consumers will be in signing up for exchange plans, and how well they will educate themselves about healthcare options. There have been analyses comparing the current level of uncertainty with that experienced when the Medicare Part D program went into force in 2007. “There are some parallels, but many differences,” says Foster. “Back then, it was getting seniors to use Web tools for which they were relatively unfamiliar; today, it’s Web-savvy ‘young invincibles’ making healthcare decisions.” But the biggest difference is that Medicare Part D was essentially one program from one provider (CMS), while the exchanges will have insurance plans from many different providers.