Q&A: Why Managed Care Still Doubts TrumpRx's Savings Claims

Six months after its February launch, TrumpRx continues to face questions from managed care professionals about whether the platform translates into meaningful savings for patients.

In this Q&A with Pharmaceutical Commerce, Adam Colborn, vice president of government affairs at the Academy of Managed Care Pharmacy (AMCP), digs deeper into the results of an AMCP member survey of 59 managed care professionals, examining what the findings suggest about patient access, the reliability of TrumpRx pricing and how the platform stacks up against the affordability resources patients already use.

TrumpRx launched in February. What did AMCP set out to learn about its real-world impact?

TrumpRx is obviously a hot topic right now, and one of the big questions that I think was outstanding, and this is something that the TrumpRx website alludes to, is how this interacts with patients' benefits.

On the TrumpRx website, especially before it launched the shopping function where you could compare prices at Cost Plus or Amazon, most of the drugs listed had a description. They had a little blurb that said, "You may get cheaper prices through your insurance than going through TrumpRx." We also saw the Federal Trade Commission settlements with first, Express Scripts, but then some other ones later that required the standard plan offering of these PBMs to incorporate TrumpRx spending and count it toward a patient's deductible when the system was in place to allow that.

We were really just trying to get a grasp on how our members who work at health plans and PBMs were thinking about TrumpRx and how it relates to the patient experience in using their benefits.

84% of managed care professionals reported they haven't referred patients to TrumpRx. Where are patients finding better prices instead?

One thing to keep in mind is that our members responding to this survey work at health plans and PBMs. They're not the type of health care professional who would typically refer a patient to TrumpRx.

We were actually surprised that slightly over 15% of respondents said they had referred a friend or family member; we asked them in their personal capacity, not as a professional. Not a huge percentage, but 15-16% is a decent chunk saying "at least take a look at it."

The caveat is that a majority of respondents either disagreed or strongly disagreed that TrumpRx offers patients the lowest available price for their medications, which I don’t think is controversial. As I mentioned, the TrumpRx website says that if you have benefits, that could be a lower cost than going cash through TrumpRx.

A little bit more on the results: more than half of respondents said that they are concerned or extremely concerned about patients' ability to access medication through the program. What that probably reflects is that in the TrumpRx program, especially as it launched, a lot of the products on it were high-cost brand drugs. Conceivably, there could have been some large negotiated discount, but the cash price is still hundreds to thousands of dollars. It may have come down quite a bit, but if you're starting at $5,000 and the discount is 50%, it's hard to imagine a typical cash patient benefiting from that.

Overall, the results point to a disconnect between the program's messaging and how managed care professionals view its value in real-world patient care, even though there are some who say, "at least take a look at it."

More than half of respondents don't think TrumpRx offers the lowest prescription prices. Does that signal MFN deals are more of a headline than real savings for patients?

I think it's difficult to say at this point. We're six months or so into the program. Patients have already had an established range of affordability resources, whether that's their benefits or some other program like a manufacturer savings program or pharmacy discount program. Depending on the type of drug they're on as well, many generics are extremely low price, single-digit dollars to fill. So, depending on the nature of the prescription, those could be affordable at a cash price, regardless of benefits.

I think it's a balancing act between what's available on the website and what channels patients are already going through. What I would say, at least as it goes to the headline number, is that a lot of those products have generic competition on the market already that was not reflected in the TrumpRx platform. So, I would say it's probably not reflective. I don't want to say that there are no savings that have been realized. I don't think we'll have access to that information for a while, but I would say at this point, it is probably more messaging than true data.

One thing that I will throw out there is that there's a potential upside to having a publicly available benchmark price. Especially for insured patients. That is an opportunity for their benefits, their insurance plans, to take that price and say, "Okay, this is the price that we are looking to beat for our own benefits." And so that could produce overall downward pressure on drug prices. I think GLP-1s are a great example of that, where we saw the TrumpRx price negotiation actually was quite a bit lower than other cash prices we had seen. And so now, as the PBM or the health plan, that's the number that you know you want to beat, which is pretty valuable.

Over half said they're concerned about patients' ability to access meds through TrumpRx. What's driving that?

We didn't have any open-ended questions, so I'm sort of trying to interpret the data here on my own, but I think what it comes down to is that affordability and access are not necessarily the same thing. Access, when we think about it broadly, includes affordability, but in some cases with a lot of the TrumpRx drugs, you have to go into a physical pharmacy with a coupon. If you are in a pharmacy shortage area, the fact that there is a low cash price available through TrumpRx or GoodRx does not necessarily mean that you'll be able to cash in that coupon. Many pharmacies, even if you are in an area with pharmacies, may not choose to participate in these coupon programs because the financials for that pharmacy don't make sense, right? They would be taking a loss on the drug, and so they may decline to participate in that type of coupon program.

When you layer multiple systems on top of each other that aren't talking to each other, and this isn't something that's unique to TrumpRx, there are lots of different pieces of our healthcare system that don't talk well to each other, but when you layer those on, it increases patient confusion. Then they have to determine whether, one, “is this a cheaper option for me than going through my benefits?” And that probably depends. That's going to be highly variable, highly individualized. But then, “is there a pharmacy near me that participates in this system?” Because if you're a patient, the worst-case scenario is that you print out this coupon and you take it into a store and they tell you “no.” Then you go to multiple stores, or you're calling around, and they're all saying, "no, we're not participating in this."

The takeaway from the survey is that the results indicate that TrumpRx has not yet demonstrated how it will improve the overall patient experience, not just advertise lower prices. What TrumpRx is doing is not novel. I think the shoppability piece is actually maybe the more interesting piece, where you can compare prices across Amazon and Mark Cuban Cost Plus and GoodRx. That's pretty interesting. But this is a model that has existed, and it hasn't really demonstrated how it's going to simplify things for patients other than being maybe a more high-profile endeavor. I think they still have a little bit of work to do on that front. Plans are thinking about this a lot. Obviously, the FTC settlements have sort of put a stake in the ground and said that at some point the government will promulgate rules that will require you to do this. So I think it's just interesting to watch how they handle that.

One thing we didn't really mention, but is worth paying attention to, is the rise of manufacturer-operated direct-to-consumer programs like Lilly Direct. Those also factor into the TrumpRx equation, but it's not clear how all of these different options then interface with the patient's benefits.