Most adults in new polling said prescription drug costs are unreasonable, with nearly one in three not taking medications as prescribed at some point.
According to the Kaiser Family Foundation, those patients either skipped a dose, cut pills in half or took an over-the-counter drug instead. Affordability especially is a problem for people taking four or more prescriptions, those with chronic conditions and households with incomes less than $40,000 a year.
Antonio Ciaccia, CEO of Ohio-based 46brooklyn Research and president of 3 Axis Advisors, formerly of the Ohio Pharmacists Association, said each year, consumers are paying more and more for prescriptions.
“Brand-name drugs are increasing their list prices to the tune of around 4% to 5% on average,” Ciaccia reported. “And on top of that, you have new drugs that are entering the marketplace that are more expensive than the ones that just existed the year before.”
AARP data found the yearly cost of prescription-drug treatment increased 26% in Ohio between 2015 and 2019, while incomes only rose 14%.
While each player in the prescription-drug marketplace influences prices, Ciaccia pointed to pharmacy benefits managers (PBMs), the middlemen who decide which drugs will be covered and at what cost to the patient.
He explained instead of drugmakers competing to lower prices, they provide rebates and discounts to the benefits managers in exchange for covering their products.
“Drugmakers are being shaken down for bigger and bigger discounts,” Ciaccia asserted. “And to accommodate for those discounts, they raise the prices. And so the PBM that is supposed to be working on our behalf can get kickbacks, and that dynamic is creating an artificial inflation in prices.”
Ohio took steps to reform PBMs after a 2018 investigation revealed two PBMs working on behalf of Medicaid-managed care plans billed the state for almost a quarter-billion dollars more than they had paid out to pharmacies for medications.
Ciaccia called for better accountability and transparency.
“We only uncovered this $244 million dumpster fire in Ohio because of what little transparency we had,” Ciaccia contended. “And more public access to granular levels of drug price data can help us better diagnose dysfunction at the pharmacy counter.”
The Pharmaceutical Care Management Association insists PBMs help reduce the cost of insurance premiums for consumers. Meanwhile, the Federal Trade Commission is investigating the impact of PBM practices and seeking public comment.
Reporting by Ohio News Connection in association with Media in the Public Interest and funded in part by the George Gund Foundation.