Everyone knows you can’t compare apples and oranges. Yet that’s exactly what prescription drug affordability boards do when they make decisions about value.
Now, a new video from the Value of Care Coalition outlines how this one-size-fits-all approach ignores clinical differences between medications and the unique needs of each patient.
Where do PDABs Get their Guidance?
Prescription drug affordability boards receive guidance from academics and economists.
Their recommendations often take a one-size-fits-all approach to lowering health care costs. But this approach to medicine doesn’t take into account what patients and clinicians actually need.
As the video explains, while some prescription drugs treat the same conditions, what works for one patient might not work for another. For example:
- A patient with Parkinson’s disease who struggles to swallow may depend on a dissolvable medication.
- A patient undergoing chemotherapy may require lower-dose formulations due to compromised organ function.
Additionally, ignoring clinically meaningful differences in drug formulations can further compound overall health care costs.
A forced switch to an alternative therapy can create higher out-of-pocket costs for patients, and negative health outcomes resulting from the switch may even require a higher, costlier degree of care.
Clinicians Know Best
When asked in a new survey about therapeutic alternatives, less than a third of specialist clinicians said that all therapeutic options indicated for the same condition should be considered therapeutic alternatives.
Clinicians know best, and maintaining access to the best treatments for their patients is a priority. Unfortunately, the PDAB model ignores meaningful differences in treatments in favor of on-paper cost considerations, despite the real-world impact.
By comparing an injectable version of a drug for those with digestive issues to an extended-release formulation of the same drug meant for patients who struggle with adherence, government regulators are essentially comparing apples to oranges.
A plurality of doctors in the new survey agree that the appropriateness of an alternative depends on the individual patient’s clinical needs and preferences.
In fact, most specialists surveyed would not even be willing to switch their patients to another drug in the same class.
Making Treatment Decisions
Patients and their clinicians need the opportunity to decide which medication works for them. This means prescription drug affordability boards should take guidance from patients and providers, not academics and economists.
This patient-centered approach to care will improve patients lives, lower overall health care spending and empower patients to take control of their disease.