As states implement, or consider creating, prescription drug affordability boards with authority to cap pharmaceutical drug prices, a recent survey of independent pharmacists should serve as a warning about the unintended consequences of upper payment limits.
Unintended Consequences
In August, the Centers for Medicare and Medicaid Services used their authority under the Inflation Reduction Act to negotiate and set prices for 10 Part D medications, with the lower negotiated prices to go into effect in 2026. Advocates warned that capping drug prices could end up limiting patient access, while not saving patients money.
Recent findings of the National Community Pharmacists Association validate these concerns. The Association’s survey data shows that, because of the to-be-implemented price caps and related reimbursement concerns, 51% of independent pharmacies are strongly considering not stocking the impacted drugs. Another 40% are somewhat considering not stocking the drugs. If pharmacies can’t afford to stock the drugs, patients may have trouble getting their medication.
This comes at the same time several chain pharmacies are announcing plans for closures across the country.
With state prescription drug affordability boards taking a similar approach to cap prices, similar outcomes may be on the horizon.
A Complex System
The Value of Care Coalition regularly notes that by simply looking at top-line prices, prescription drug affordability boards take a very narrow view of a very complex system. For example, concerns abound that the implementation of upper payment limits could have downstream effects in the supply chain that impede patient access. This could result from PBM formulary construction, health plan utilization management, or pharmacists’ and doctors’ inability to stock a medication, for example.
While each board has heard these concerns, it remains unclear how they plan to mitigate these unintended consequences. Recent board discussions seem to favor a “we won’t know what happens until we do it, so let’s give it a try” approach.
If it’s a crystal ball they’re looking for, the National Community Pharmacists Association’s survey might provide insights.
As noted by their CEO, B. Douglas Hoey, “Lower prices won’t mean much to people who can’t find the drugs.”