It’s a late-arriving Curve today because I’m on the road talking to people in the flesh like it’s 2018 or something.
They’ve been great meetings, with some interesting reader feedback, including the observation that I use the word “dull” a lot. There’s a lot to unpack there …
There’s new CDC data on prescription drug use generally — and cost-related non-adherence more specifically — in the 65-plus demographic (in other words: the Medicare population). It’s worth reading the whole thing just to get a sense of what that group looks like. The data are from 2021-2022.
Most people are going to skip to the cost-related pieces, but the overall picture also provides good context, showing that prescription drug use is pretty much universal in that population. That’s a reminder of how invested seniors are in discussions about medications: it’s a constant part of life in a way that isn’t necessarily true for the general population.
But the cost data — “Percentage of adults age 65 and older who did not get prescription medication due to cost and did not take medication as prescribed to reduce costs in the past 12 months” — will probably get more attention, and appropriately so.
The number here is not large in an absolute sense: 3.6% of the 65+ population falls into the overall category. About 2.2% of those assessed took less medicine, 2.7% delayed filling a script, 1.7% skipped doses. Those numbers were all higher for vulnerable populations.
But this is a place where that number should be zero. The safety net should have no holes. Cost-related non-adherence, especially in Medicare, should not be a thing. Every percentage point here is indicative of a failure.
I suspect that some of the failure is due to the Part D benefit design, which — in 2021-2022 — hung a huge amount of costs on a small population of patients. In theory, the $2,000 out-of-pocket cap and smoothing provisions should help. I don’t know if that will solve the entire problem, but it feels like should have a substantial impact.
That’s not enough, though.
What would it take to understand what’s going on with every one of those patients who cannot take their medicines as prescribed? The safety net may have a thousand small holes that need to be patched. Can we catalogue and eliminate each of those holes?
The model here is Volvo, which investigates every crash involving a Volvo in Sweden to better understand how and why accidents happen. I realize that such an undertaking is impossible in health care — privacy laws exist for a reason — but it feels like there’s a need for a similar effort around cost-related non-adherence.
And the 65+ population is just the place to start because Medicare should, in theory, provide a strong, level floor (at least compared with the Tower of Babel that is private insurance).
Getting to zero might not be possible, but that doesn’t mean it can’t be a goal.
I’m sure I’m not the first person to have had this thought, and I welcome perspective on past efforts to wrap arms around this issue.
My erstwhile colleague Gary Karr used to get a chuckle out of groups that announced “seven-figure” ad campaigns. Gary’s belief — and he ain’t wrong — is that an investment of a million dollars (seven figures!) is a darn sight less impressive than an investment of $9 million, but something about the “seven-figure” turn of phrase implies Benjamins flying all over the place. Anyway: the Campaign for Sustainable Rx Pricing is launching a “seven-figure” campaign on drug patent reform, per Axios. It’s not clear to me if they’re pushing for a specific legislative package, but — hey — they’re spending seven figures.
I am frequently critical of obesity-med stories that present the costs of the medicine in a vacuum, as if there is no offsetting benefit. In the interest of balance, you should know that I’m pretty cool on this Real Clear op-ed suggesting that Medicare coverage of obesity indications is a slam-dunk political winner. It commits the mirror-image sin, failing to grapple with the cost implications.
The silence around smoothing is getting deafening. The Medicare Prescription Payment Plan (or MPPP or M3P) is going to kick in in, like, four months, and no one — most of all seniors — is quite sure how it works or what it will mean. Jennifer Snow unpacked how the process will work for different patients in this LinkedIn post that probably ought to be required reading.
It’s been a big week for deep thinking about biosimilars, including this Adam Fein post that looks at the transformation of the market for Humira biosimilars over the past six months. I’m still waiting for the definitive explainer on the money flow with white-labeled biosimilars from Quallent and Cordavis, but Adam does a great job of building the foundation.
Vermont is pushing forward with its importation effort. Maybe Vermont is small enough that it can fly under the radar where others (e.g. Florida) are likely to fail. But I doubt it.
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