The rising cost of medicines has prompted yet another large group of physicians to speak out.
The American College of Physicians, the largest medical society in the country, is calling for a set of familiar yet controversial actions to curb price hikes and improve patient access.
For instance, the society, which has about 143,000 members across the US, believes that Americans should be allowed to import medicines from other countries, a suggestion that has wafted through Congress several times over the past few years but never gained traction.
The organization also believes that drug makers should disclose their actual production costs, including research and development, used to set to pricing. Several state legislatures, as well as the Obama administration, have proposed the same thing, since drug makers say prices reflect the high cost of R&D efforts.
Other ideas include allowing Medicare to negotiate prices with drug makers and expanding the mandate of the Patient-Centered Outcomes Research Institute, an independent nonprofit created by Congress in 2010, so that it can legally use a tool to evaluate the cost-effectiveness of medicines. Other governments already use this approach.
“There’s been a skyrocketing of drug prices, in general, and for certain specialty drugs, in particular, that have made access for our patients a huge problem,” said Dr. Thomas Tape, who is chairman-elect of the American College of Physicians’s Board of Regents and chief of general internal medicine at University of Nebraska Medical Center.
“We want to make it publicly known that ACP feels this is a problem and so we’re calling for action from Washington — Congress and the administration — to do what can be done,” he told us. “We also want the companies to be aware of the fact that we recognize this is a growing problem that interferes with the optimal care of our patients.”
This is hardly the first time that physicians have become outspoken over drug prices.
Four years ago, physicians at Memorial Sloan Kettering Cancer Center in New York caused a ruckus when they wrote a prominent editorial complaining about the cost of a new Sanofi drug. Last year, the chairman of the leukemia department at the MD Anderson Cancer Center in Houston picked up on that theme and launched a nationwide petition to urge Congress to take action over cancer drug prices.
Last November, the American Medical Association urged Congress to ban direct-to-consumer advertising, which the organization believes drives up costs because drug makers typically advertise the newest and most expensive medicines. Recently, dozens of specialists penned an editorial in a medical journal to voice concern that the price of a rare-disease treatment may increase substantially.
Of course, physicians are hardly the only ones complaining about high drug prices.
A poll conducted late last year by STAT and the Harvard T.H. Chan School of Public Health found that 76 percent of the public believes that brand-name prescription drug prices are unreasonably high. Several congressional committees have held hearings into moves by Valeant Pharmaceuticals and Turing Pharmaceuticals to buy drugs and then jack up prices. And the Obama administration held a forum on combating medicine costs.
But quick solutions may be hard to come by.
The pharmaceutical industry regularly maintains that pricing funds needed investment and has previously argued against some of the proposals embraced by the American College of Physicians.
Drug makers, meanwhile, maintain that importation would make it easier for counterfeit medicines to creep into the supply chain. Requiring companies to disclose R&D costs for each drug can be difficult to separate while such efforts overlook the role played by insurers and pharmacy benefit managers in setting prices.
What else does the American College of Physicians want?
The organization opposes extending market or data exclusivity periods beyond the current time frames granted to drugs. And the medical society wants greater oversight and enforcement of restrictions on moves that companies make to extend patents for their medicines, such as slightly tweaking products to suggest greater use, and reaching settlements with generic rivals that delay the launch of copycat versions.
The group also supports indication-specific pricing, which would involve setting a price for a drug based on how well a medicine works. For example, if one drug is approved to treat two cancers, but is more effective in one than the other, the pricing would reflect the different outcomes. Earlier this month, the Obama administration said it would explore this approach as part of an experiment to lower costs for Medicare Part B drugs.
A spokeswoman for the Pharmaceutical Research and Manufacturers of America, the industry trade group, wrote us this: “These far-reaching recommendations are driven by the false notion that spending on medicines is fueling overall health care cost growth and ignores how the competitive marketplace for medicines helps keep spending in check.
“In reality, government actuaries project spending on prescription medicines will grow in line with overall health care spending through the next decade – despite the expected introduction of many new first-in-class medicines. This is possible due to a competitive marketplace for medicines where large, powerful purchasers negotiate aggressively and generic utilization rates are nearly 90 percent.”
This story was updated to include a comment from the pharmaceutical industry trade group.