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Medscape
4 days ago
- Health
- Medscape
Restricted Drug Coverage Tied to Higher Risk for MS Relapse
Restricted coverage of medications for relapsing-remitting multiple sclerosis (MS) was associated with a higher risk for relapse, a new study showed. Patients with MS enrolled in Medicare Advantage Prescription Drug plans (MA-PDs) with broader formulary coverage were 8%-12% less likely to experience an MS relapse, while those in broad-coverage stand-alone prescription drug plans (PDPs) had 6%-9% lower odds of relapse. The findings highlight that cost-saving measures used by pharmacy benefit managers to exclude certain drugs from formularies can have tangible negative outcomes, especially for patients with complex or chronic conditions. 'Patients with MS may need to try multiple drugs to find what works best for them. Broad formulary exclusions ultimately undermine the individualized care these patients need,' said lead author Geoffrey Joyce, PhD, director of Health Policy at the Schaeffer Center and chair in the Department of Pharmaceutical and Health Economics at the University of Southern California in Los Angeles, in a news release. The study was published online on August 1 in JAMA Network Open . Cost-Cutting May Come at Patients' Expense Part of the push to exclude certain medications or seek rebates is due to the increasing number of therapies within the same class, the investigators noted. Competition among manufacturers allows pharmacy benefit managers to negotiate better prices via the exclusion of more costly drugs from their formulary. This can prevent some patients from getting their prescribed medication, such as drugs for relapsing-remitting MS, which are not protected by Medicare's Part D classifications. A 2024 study showed that Medicare Part D plan formularies excluded an average 44.7% of brand-only compounds and that drug restrictions for this plan increased over the study period of 2011-2020. To investigate whether such exclusions were associated with relapse episodes for MS patients, the researchers analyzed Medicare data of 50,162 beneficiaries in PDPs (mean age, 58.5 years; 74.9% women; 80.7% White) and 34,708 in MA-PDs (mean age, 58.2 years; 77.2% women; 75.5% White). More MS Therapies, Less Coverage The study timeline was divided into quarters, starting in 2019 (2020 Q2 was left out as a result of COVID-19 disruptions). To gauge patient outcomes, the first four quarters were used as a baseline period and the fifth quarter as the follow-up period. Beneficiary severity of MS was evaluated using the expanded disability status scale derived from the disability/impairment scores. The researchers looked at 15 disease-modifying therapies (DMTs) on the market from 2018 to 2022. In their analysis, the Medicare plans were assumed to cover the five intravenous MS DMTs. The amount of on-formulary MS DMTs was calculated to give a four-quarter moving average and DMTs were classified as on formulary if their generic name was covered by the plans. Plans were deemed low coverage if the four-quarter moving average of DMTs was below the plan's median during baseline. For the follow-up portion, logistic regression models were employed for MS relapse episodes, and Poisson or negative binomial regression models were used for nonbinary dependent variables such as the number of relapse episodes. Multivariable regression models were used to control for patient characteristics. PDPs typically covered only four of the 15 drugs across four classes, while MA-PDs covered double this across five classes. Many oral and injectable DMTs were frequently not covered by plans particularly in stand-alone plans, such as teriflunomide (amount of plans without compound on formulary: PDP, 87.7%; MA-DP, 43.3%), ofatumumab (PDP, 99.6%; MA-DP, 86%), and interferon beta-1a (PDP, 86.5%; MA-DP, 41.4%). The rate of any MS relapse was higher for low-coverage plans compared with broader coverage plans for PDPs (10.6% vs 9.5%; odds ratio [OR], 0.88 [95% CI, 0.85-0.91]) and MA-PDs (7.8% vs 6.9%; OR, 0.88 [95% CI, 0.84-0.92]). MS is most commonly diagnosed between 20 and 40 years of age — a limitation of the study was that most Medicare beneficiaries are older than this cohort. Other limitations were potential administration errors inherent in health claims data and that quarterly periods might not be sufficient to fully evaluate the relationship between formulary coverage and relapse episodes. The researchers noted that the effect of such restrictions might be exacerbated for Part D beneficiaries, thanks to the new $2000 annual cap on out-of-pocket drug expenses. 'Innovative new treatments have made it possible to slow or prevent symptoms for some of the most complex diseases, but costs remain a challenge,' Joyce said. 'We must find sustainable ways to ensure all patients can access these potentially life-changing treatments.'
Economic Times
05-08-2025
- Health
- Economic Times
Trump says he's cut drug prices by up to 1,500%. That's not possible
Synopsis Donald Trump claimed significant drug price cuts, even up to 1500%. Experts refute this, stating such cuts are impossible. They suggest it would mean people are paid to take medicine. The White House defended Trump, citing price differences with other nations. Trump also mentioned future price drops. Some drugmakers are open to cuts. AP Days after he sent letters instructing top pharmaceutical manufacturers to use a "most favored nation" pricing model for prescription drugs, President Donald Trump told reporters on Sunday that he had cut costs by up to 1,500%. But Trump's grandiose claim is mathematically impossible. Here's a closer look at the facts. TRUMP: "You know, we've cut drug prices by 1,200, 1,300, 1,400, 1,500%. I don't mean 50%, I mean 14 - 1,500%." THE FACTS: This is false. Cutting drug prices by more than 100% would theoretically mean that people are being paid to take medications. The Trump administration has taken steps to lower prescription drug prices, but experts say there's no indication costs have seen such a massive drop. Geoffrey Joyce, director of health policy at the University of Southern California's Schaeffer Center, called Trump's claim "total fiction" made up by the Republican president. He agreed that it would amount to drug companies paying customers, rather than the other way around. "I find it really difficult to translate those numbers into some actual estimates that patients would see at the pharmacy counter," said Mariana Socal, an associate professor of health policy and management at Johns Hopkins University who studies the U.S. pharmaceutical market. She added that Trump's math is "really hard to follow." Asked what Trump was using to back up his claim, White House spokesman Kush Desai said: "It's an objective fact that Americans are paying exponentially more for the same exact drugs as people in other developed countries pay, and it's an objective fact that no other Administration has done more to rectify this unfair burden for the American people." The White House provided a chart of price differentials for drugs in the U.S. and comparable countries, but did not offer any other evidence. On Sunday, Trump also described cuts to drug prices as a future development, not that already happened. "So we'll be dropping drug prices," he said. "It will start over the next two to three months by 1,200, 1,300 and even 1,400%." Prices for most prescription drugs - unbranded generics are the exception - are higher in the U.S. than they are in other high-income countries. This is in large part due to the way drug prices are negotiated in the United States. Trump made his recent appeal in letters to 17 pharmaceutical manufacturers, the White House announced last week. He asked them to reduce costs in the U.S. by matching the lowest prices of prescriptions drugs in other comparably developed countries. Some drugmakers have since indicated that they are open to cutting costs. This move follows an executive order Trump signed in May setting a 30-day deadline for drugmakers to electively lower prices in the U.S. or face new limits in the future over what the government will pay. The federal government has the most power to shape the price it pays for drugs covered by Medicare and Medicaid. It's unclear what - if any - impact the Trump administration's efforts will have on millions of Americans who have private health insurance. Socal pointed out that if drug manufacturers had cut costs to the extent Trump claims, they would be shouting it from the rooftops, especially given the heat they've taken over the years for their pricing practices. "My expectation would be that they would make announcements - public announcements - and that those announcements would come way in advance of the actual effective dates when those price cuts would come into effect," she said. Joyce agreed that there has been no indication of a substantial cut. "Not at all, not at all, none whatsoever," he said. "And let alone 1,500."
Time of India
05-08-2025
- Health
- Time of India
Trump says he's cut drug prices by up to 1,500%. That's not possible
Live Events (You can now subscribe to our (You can now subscribe to our Economic Times WhatsApp channel Days after he sent letters instructing top pharmaceutical manufacturers to use a "most favored nation" pricing model for prescription drugs, President Donald Trump told reporters on Sunday that he had cut costs by up to 1,500%.But Trump's grandiose claim is mathematically a closer look at the "You know, we've cut drug prices by 1,200, 1,300, 1,400, 1,500%. I don't mean 50%, I mean 14 - 1,500%."THE FACTS: This is false. Cutting drug prices by more than 100% would theoretically mean that people are being paid to take medications. The Trump administration has taken steps to lower prescription drug prices, but experts say there's no indication costs have seen such a massive Joyce, director of health policy at the University of Southern California 's Schaeffer Center, called Trump's claim "total fiction" made up by the Republican president. He agreed that it would amount to drug companies paying customers, rather than the other way around."I find it really difficult to translate those numbers into some actual estimates that patients would see at the pharmacy counter," said Mariana Socal, an associate professor of health policy and management at Johns Hopkins University who studies the U.S. pharmaceutical market. She added that Trump's math is "really hard to follow."Asked what Trump was using to back up his claim, White House spokesman Kush Desai said: "It's an objective fact that Americans are paying exponentially more for the same exact drugs as people in other developed countries pay, and it's an objective fact that no other Administration has done more to rectify this unfair burden for the American people."The White House provided a chart of price differentials for drugs in the U.S. and comparable countries, but did not offer any other evidence. On Sunday, Trump also described cuts to drug prices as a future development, not that already happened."So we'll be dropping drug prices," he said. "It will start over the next two to three months by 1,200, 1,300 and even 1,400%."Prices for most prescription drugs - unbranded generics are the exception - are higher in the U.S. than they are in other high-income countries. This is in large part due to the way drug prices are negotiated in the United made his recent appeal in letters to 17 pharmaceutical manufacturers, the White House announced last week. He asked them to reduce costs in the U.S. by matching the lowest prices of prescriptions drugs in other comparably developed countries. Some drugmakers have since indicated that they are open to cutting move follows an executive order Trump signed in May setting a 30-day deadline for drugmakers to electively lower prices in the U.S. or face new limits in the future over what the government will federal government has the most power to shape the price it pays for drugs covered by Medicare and Medicaid. It's unclear what - if any - impact the Trump administration's efforts will have on millions of Americans who have private health pointed out that if drug manufacturers had cut costs to the extent Trump claims, they would be shouting it from the rooftops, especially given the heat they've taken over the years for their pricing practices."My expectation would be that they would make announcements - public announcements - and that those announcements would come way in advance of the actual effective dates when those price cuts would come into effect," she agreed that there has been no indication of a substantial cut."Not at all, not at all, none whatsoever," he said. "And let alone 1,500."
Winnipeg Free Press
04-08-2025
- Health
- Winnipeg Free Press
FACT FOCUS: Trump says he's cut drug prices by up to 1,500%. That's not possible
Days after he sent letters instructing top pharmaceutical manufacturers to use a 'most favored nation' pricing model for prescription drugs, President Donald Trump told reporters on Sunday that he had cut costs by up to 1,500%. But Trump's grandiose claim is mathematically impossible. Here's a closer look at the facts. TRUMP: 'You know, we've cut drug prices by 1,200, 1,300, 1,400, 1,500%. I don't mean 50%, I mean 14 — 1,500%.' THE FACTS: This is false. Cutting drug prices by more than 100% would theoretically mean that people are being paid to take medications. The Trump administration has taken steps to lower prescription drug prices, but experts say there's no indication costs have seen such a massive drop. Geoffrey Joyce, director of health policy at the University of Southern California's Schaeffer Center, called Trump's claim 'total fiction' made up by the Republican president. He agreed that it would amount to drug companies paying customers, rather than the other way around. 'I find it really difficult to translate those numbers into some actual estimates that patients would see at the pharmacy counter,' said Mariana Socal, an associate professor of health policy and management at Johns Hopkins University who studies the U.S. pharmaceutical market. She added that Trump's math is 'really hard to follow.' Asked what Trump was using to back up his claim, White House spokesman Kush Desai said: 'It's an objective fact that Americans are paying exponentially more for the same exact drugs as people in other developed countries pay, and it's an objective fact that no other Administration has done more to rectify this unfair burden for the American people.' The White House provided a chart of price differentials for drugs in the U.S. and comparable countries, but did not offer any other evidence. On Sunday, Trump also described cuts to drug prices as a future development, not that already happened. 'So we'll be dropping drug prices,' he said. 'It will start over the next two to three months by 1,200, 1,300 and even 1,400%.' Prices for most prescription drugs — unbranded generics are the exception — are higher in the U.S. than they are in other high-income countries. This is in large part due to the way drug prices are negotiated in the United States. Trump made his recent appeal in letters to 17 pharmaceutical manufacturers, the White House announced last week. He asked them to reduce costs in the U.S. by matching the lowest prices of prescriptions drugs in other comparably developed countries. Some drugmakers have since indicated that they are open to cutting costs. This move follows an executive order Trump signed in May setting a 30-day deadline for drugmakers to electively lower prices in the U.S. or face new limits in the future over what the government will pay. The federal government has the most power to shape the price it pays for drugs covered by Medicare and Medicaid. It's unclear what — if any — impact the Trump administration's efforts will have on millions of Americans who have private health insurance. Socal pointed out that if drug manufacturers had cut costs to the extent Trump claims, they would be shouting it from the rooftops, especially given the heat they've taken over the years for their pricing practices. Wednesdays What's next in arts, life and pop culture. 'My expectation would be that they would make announcements — public announcements — and that those announcements would come way in advance of the actual effective dates when those price cuts would come into effect,' she said. Joyce agreed that there has been no indication of a substantial cut. 'Not at all, not at all, none whatsoever,' he said. 'And let alone 1,500.' ___ Find AP Fact Checks here:
