Specialty doctors are concerned about the harmful impacts of prescription drug affordability boards, a white paper commissioned by the Value of Care Coalition recently found.
The survey asked endocrinologists, rheumatologists and HIV specialists for their opinions on prescription drug affordability boards. Their responses revealed many key concerns.
Increased Medication Switching
Nearly all respondents (96%) agreed that they were somewhat or very concerned that upper payment limits could lead to non-medical switching.
Non-medical switching happens when a health plan switches stable patients off the drug that’s working for them to one that’s cheaper for the health plan. Not only is it disruptive to patient care, but it can also be dangerous for patients.
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- Less than one third of specialists said that all therapeutic options indicated for the same condition should be considered as therapeutic alternatives.
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- A plurality believes the appropriateness of therapeutic alternatives depends on the individual patient’s clinical needs and preferences.
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- The majority would not be willing to switch their patients to another drug in the same class
In addition, 100% of respondents expressed concern that decisions made by prescription drug affordability boards will lead to additional administrative burdens for staff that cut into patient care time.
Lack of Specialist Input & Patient Access Concerns
Respondents noted that, despite these boards operating for years in their states, they did not feel like they had received sufficient information on prescription drug affordability boards. In fact, 93% believe there was not sufficient knowledge-sharing between boards and doctors.
Respondents also noted that patient access and affordability were top of mind when making prescribing decisions, but they were concerned that upper payment limits could hinder availability, change prescribing patterns and impact clinical choice.
When asked about whether they were concerned about upper payment limits impacting treatment options for patients:
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- 89% of rheumatologists agreed
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- 78% of HIV specialists agreed
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- 67% endocrinologists agreed
When asked if they would avoid prescribing drugs with upper payment limits:
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- 67% of HIV specialists agreed
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- 56% of rheumatologists agreed
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- 33% of endocrinologists agreed
Notably, 93% are concerned prescription drug affordability boards unaffiliated with a state medical board will make decisions that may hinder patient access to needed medications.
Moving Forward
The results of the survey are clear: Prescription drug affordability boards have failed to meaningfully engage the very health care providers that best know the value of the treatments they’re reviewing. Despite PDABs’ efforts to set upper payment limits, specialists believe treatment decisions need to stay between doctors and their patients.
Until these boards consider their impact on individual patients’ health and specialists’ practice of medicine, doctors may view them with skepticism. As one endocrinologist stated: “there are no benefits to prescription drug affordability boards. Decisions will be based on money, not on patient safety.”