Over the past century, healthcare advances have gifted us with modern longevity, resulting in lives stretching into the 70s, 80s and 90s. The national trend of living longer highlights innovation’s vital role in healthy aging and the new challenges that come with ensuring people’s later years are healthy, active and affordable.
In several states, however, lawmakers are taking steps that could upend progress to ensure Americans live longer, healthier lives at the cost of drug “affordability reviews.” In a dozen states, legislatures have adopted policies that will make it more challenging for patients with chronic conditions to access much-needed and, in many cases, life-saving treatments and services. These policies will also be disincentives for future innovation that is the central driver of 21st-century healthy longevity.
So far, 10 states have established a Prescription Drug Affordability Board — or PDAB — to identify and examine prescription drugs that pose affordability challenges for patients. Behind these 10 states, numerous others have evaluated similar solutions to reduce costs. Though well-intentioned, these “drug affordability boards” are poised to harm the patients they were created to protect by cutting healthcare access. Let’s call it what it is: price controls.
The story unfolding in these states is like what is happening through the Inflation Reduction Act. Just as patient advocates are sounding the alarm about the effect that drug price negotiations will have on access and future innovations, patients, caregivers and providers have engaged with PDABs to express deep concerns about state efforts to institute similar price control policies. Advocates and experts have argued that PDABs will harm access for rare disease communities in Colorado and hurt cancer patients in Minnesota.
Consider the Colorado PDAB, which selected five prescription drugs in August for an affordability review, including treatments for some of the most challenging chronic conditions like HIV, cystic fibrosis and psoriatic arthritis. Patients with such conditions raised the alarm with the PDAB and explained how the drug review process would negatively affect access. Efforts to institute drug affordability boards in other states represent just the beginning of a concerning trend. State legislatures in Pennsylvania, New Jersey, Michigan and other states are all considering legislation to establish a PDAB.
PDABs in Colorado, Minnesota, Oregon and Maine already have the authority to institute Upper Payment Limits (UPLs) on innovative treatments, which, ironically, will make them inaccessible to patients while thwarting future incentives for drug discovery. Aimed at lowering healthcare costs, UPLs dictate how much that covered entities can be reimbursed when prescribing treatments to patients. Yet, restrictive payment limits can lead to fewer incentives for providers to prescribe new and innovative treatments. The signal to potential innovators is clear — put your investment somewhere else.
While these measures may save money for payers in the short term, pharmacies and providers will respond by limiting newer — often more expensive — medicines, leaving patients to bear the brunt of the long-term consequences.
Patients living with complex diseases rely on their prescribed treatment plan, but the approach that PDABS will take to lower patient out-of-pocket costs could put medications that are already working for patients out of reach. When patients don’t adhere to their necessary medication, it can lead to increased costs for individuals and the healthcare system, as patients can lose control of their disease, require extra doctor visits, and even visit the emergency room to address unmanaged symptoms. Perversely, PDABs might even lower some drug costs, but the added costs to the healthcare system through hospitalizations and doctor visits will be multiples more and, overall, a bad deal.
In a cruel twist, these unintended effects may fall hardest on the disadvantaged communities that the policy is intended to help, as UPLs often lead to new drugs and treatments getting to patients later or not at all.
While there have been significant strides to discover new treatments in recent decades, we still need new solutions for complex, age-related health challenges like Alzheimer’s disease, heart disease, cancer, bone health, people living with HIV, and more. Unfortunately, price limits will undercut the incentives to research and discover such innovations.
These boards will bypass the competitive system that has resulted in a decline in the average price of drugs and held down even branded drug prices for years. If the government refuses to reimburse a drug, biopharmaceutical companies could be forced to stop supplying that drug.
Price controls threaten patient access to life-saving medicines in the near term but could also weaken health systems, deter future innovation, and derail healthy aging over the long term, paradoxically adversely affecting health equity. But there is still an opportunity to reverse course — and embrace innovation for healthy aging, resilient health systems, and policies that ensure a sustainable future for healthy longevity that will also support health equity goals.
