PAP Series: Patient Assistance Programs “Culprits” of Rising Drug Prices

Playing the Blame Game

A recent analysis by the social data-mining company, Treato, suggests that drug companies might face an uphill battle if they want to reframe the controversy over drug prices as an insurance co-pay issue.⁵

“If pharmaceutical companies want more credit for providing discounts for high-cost drugs, they are going to have to improve their relationships with patients, which could be achieved through further education about how much the companies invest in getting a new drug to market,” said Pamela Batzel, Treato’s Senior Director of Consulting Services.

Treato is a big-data “social listening” company that uses natural language processing content-analysis algorithms to sift and initially analyze patients’ online conversations about prescription drugs on social-media platforms like Facebook and Twitter, and dozens of patient discussion forums, mainly for drug company clients. Then human analysts follow up with content analyses of subsets of the captured conversations.

To determine how patients with cancer view PAPs, Treato gathered and analyzed more than 191,000 online patient conversations from 2015 and 2016 about drug costs from 26 unspecified online patient discussion groups. They then selected a subset of 268 individual posts specifically about the prostate cancer drug, enzalutamide, the breast cancer drug, palbociclib (Ibrance), and the blood thinning agent, rivaroxaban (Xarelto), Batzel told Cancer Therapy Advisor.

PAPs were a “focal point in online conversations regarding all 3 drugs,” Treato concluded. Patients have come to expect price discounts and co-pay assistance on these drugs precisely because they have become very expensive, Treato concluded. Enzalutamide costs more than $9600 for a 30-day treatment; palbociclib exceeds $10,600 per 21-day cycle of once-daily pills.

PAPs seem to be working, however, as critics say they are meant to do: few patient conversations mentioned seeking cheaper alternatives when assistance is available, the Treato study found.

Will the Next President Intervene?

The Turing episode caught the attention of US presidential candidates, who pledged to curb drug-price inflation. Both Hillary Clinton and Donald Trump voiced support for allowing patients to import medications from other countries, where the cost may be lower, and to allow Medicare to negotiate with drug companies for better prices.

The federal government negotiates prices for US Veterans Health Administration and Indian Health Service beneficiaries, but the 2003 Medicare Prescription Drug, Improvement, and Modernization Act bans the US Department of Health and Human Services, which oversees Medicare, from doing so.

Drug prices for Medicare would likely have an outsized effect on prices overall because with 40 million beneficiaries, Medicare is the country’s largest insurance program, Fugh-Berman pointed out.

There is, however, significant opposition to such proposals in congress. House Ways and Means Committee Chairman Kevin Brady (R, TX) announced that he opposes allowing Medicare to negotiate prices.⁶

Without congressional support for a long-term solution, uninsured and underinsured patients will continue to be caught in the fight between insurers and drugmakers. Many will have little choice but to rely on PAPs.

“The country needs a long-term solution to address rising treatment costs instead of relying on non-profit charitable organizations,” Dana Kuhn, founder and president of the PAP nonprofit Patient Services, Inc., wrote in an opinion essay for the Washington Post. But until that happens, PAPs are needed to make sure patients don’t fall through the cracks, he wrote.

References

1. Kuhn D. Opinion: Nonprofits serve as a bridge to better health care. The Washington Post. https://www.washingtonpost.com/blogs/all-opinions-are-local/wp/2016/08/03/nonprofits-serve-as-a-bridge-to-better-health-care/. Updated August 3, 2016. Accessed August 8, 2016.
2. Elgin B, Langreth R. How big pharma uses charity programs to cover for drug price hikes: a billion-dollar system in which charitable giving is profitable. Bloomberg Businessweek. http://www.bloomberg.com/news/videos/2016-05-23/how-big-pharma-uses-charity-programs-to-cover-price-hikes. Updated May 23, 2016. Accessed Aug. 8, 2016.
3. Dennis B. Prescription drug prices jumped more than 10 percent in 2015, analysis finds. The Washington Post. https://www.washingtonpost.com/news/to-your-health/wp/2016/01/11/prescription-drug-prices-jumped-more-than-10-percent-in-2015/. Updated January 11, 2016. Accessed Aug. 8, 2016.
4. Elgin B, Langreth R. Celgene accused of using charities ‘scheme’ to gain billions. Bloomberg Businessweek. http://www.bloomberg.com/news/articles/2016-08-01/celgene-accused-of-using-charities-in-scheme-to-gain-billions. Updated August 1, 2016. Accessed Aug. 8, 2016.
5. Treato finds patients expect discounts on high-cost drugs. Treato website. https://newsroom.treato.com/treato-finds-patients-expect-discounts-on-high-cost-drugs. Updated July 19, 2016. Accessed Aug. 8, 2016.
6. Ferris S. GOP chair won’t back Trump on negotiating Medicare drug prices. The Hill. http://thehill.com/policy/healthcare/288395-gop-chairman-wont-back-trump-on-medicare-price-negotiation. Updated July 19, 2016. Accessed Aug. 8, 2016.