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How to Control Specialty Drug Prices: Pharma Companies and Insurers Need to Talk

Regulatory change is in the works

More dialogue between drug-makers and insurers would ease the pain for both insurers and patients when expensive new drugs hit the market, representatives from the pharma and insurance industries told Morning Consult

Part of the reason drug spending is on the rise in the U.S. is because manufacturers are developing more specialty medications aimed at small populations of patients. These drugs are expensive to make.

Moreover, new drugs often hit the market after insurers have set their rates for the year, which means that either the insurance plans or the patients have to pay the price. 

“Say, for example, a drug comes out in September [or] October, and we didn’t have a window into what those costs would be. Plans didn’t anticipate or factor that into their rates. That could be a huge pressure for premiums. It could be a huge pressure for patient costs,” Clare Krusing, a spokeswoman for America’s Health Insurance Plans, told Morning Consult.

To allow communication between drug-makers and insurers to happen, the FDA would have to make a regulatory change. This is already in the works. A provision in the 21st Century Cures bill, passed by the House, would require the FDA to issue guidance clarifying how drug manufacturers can communicate scientific and medical information to insurers before and immediately after a drug has been approved.

The issue is especially relevant in light of the fact that more than 2,300 drugs are in the late-stage pipeline, Morning Consult says. Of the 630 research programs nearing completion, 37% are for specialty drugs, according to a report issued earlier this month by the Institute for Healthcare Informatics.

Source: Morning Consult; April 19, 2016.

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