The Role of Advance Purchasing Commitments in Government Drug Price Negotiations: Lessons From the COVID-19 Response

Among the various approaches to address rising prescription drug costs, one option is to allow the federal government to negotiate prices directly with drug manufacturers. Debates over the appropriate negotiating approach have occurred on several dimensions,1 including the number of drugs eligible for negotiation, the levers that would be implemented to obtain lower prices, the incentives necessary to ensure that all parties negotiate in good faith, and what specific populations should have access to the negotiated price. In 2019, the US House of Representatives passed the most recent proposal to allow the federal government to negotiate prices—H.R.3, The Elijah E. Cummings Lower Drug Costs Now Act—reflecting policy decisions on many of these issues.2 (Am J Public Health. Published online ahead of print January 28, 2021: e1–e6. https://doi.org/10.2105/AJPH.2020.306109 )

People with Colorectal Cancer in SEER-Medicare: Part D Uptake, Costs, and Outcomes

Limited information exists about enrollment in Part D prescription coverage by Medicare beneficiaries with cancer. Part D coverage may increase access to medicines. This study evaluated patterns of Part D uptake and costs and assessed the effects of coverage on hospitalizations and emergency department (ED) use among people with colorectal cancer (CRC). We analyzed Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data on fee-for-service (FFS) Medicare beneficiaries with at least 36 months of follow-up who were diagnosed with CRC at any point from January 2007 through December 2010, and a matched cohort of beneficiaries without cancer. Dual (Medicare/Medicaid) enrollees were excluded because they are automatically enrolled in Part D. Among beneficiaries with CRC (n=12,774), 39 percent had complete Part D coverage, defined as coverage in the diagnosis year and 2 subsequent years; the rate was 38 percent in the matched comparison cohort (P=.119). Among those with complete Part D coverage, there was no significant difference in annual prescription drug costs between people with CRC ($3,157, 95% confidence interval [CI]: $3,098–$3,216) and without ($3,113, 95% CI: $3,054–$3,172). Among people with CRC, odds of ED use ranged from unchanged to marginally higher for those with no or partial Part D coverage, (adjusted odds ratio: 1.09, 95% CI: 1.00–1.18), compared with those with complete Part D coverage. Lack of continuous Part D coverage was associated with more ED use among Medicare FFS beneficiaries with CRC in 2007–2013. Among people with Part D coverage, prescription drug costs varied little between those with CRC and matched beneficiaries without cancer.

Panel-based methodology for assessing the impact of public policies on cancer patients and survivors.

12059 Background: Cancer interventions are subject to a range of regulations, but data from large, nationally representative surveys are not always available in time to inform the policy process and do not always address issues specific to cancer patients and survivors. Understanding their experiences is critical to achieving policy solutions to issues such as access to effective pain relief, reducing unexpected medical bills, and reducing the impact of high prescription drug costs on treatment for lower income cancer patients. This research intended to better understand patient experiences and opinions in a statistically valid manner specifically targeted to the policy process. Methods: 3057 panelists were identified from ACS contacts, health systems, and social media advertising through ACS/ACS CAN pages and paid Facebook ads, to participate in a series of surveys across a year. The panel included diverse survivors across age, gender, race, ethnicity, economic status, and cancer type. Online surveys deployed semi-monthly on cancer survivorship topics impacted by current policy, including access to/affordability of care, pain treatment, and prescription drug costs. Responses were analyzed for the entire population and across subgroups of cancer survivors. Results: Each survey achieved a response rate between 35% and 50% of all panel members, resulting in a margin of error +/- 3% and 95% confidence level. Insights from cancer patient and survivor experiences helped support public policies through findings such as (but not limited to): 41% of those prescribed opioids had trouble getting their medicine, creating difficulty participating in work, family, or social events; extra trips to the doctor or pharmacy; negative impact on treatment, and trips to the Emergency Room due to uncontrolled pain; 24% received a surprise medical bill, increasing their anxiety, reducing likelihood to see a specialist, and reducing likelihood to seek emergency care during a serious health issue; and 31% of those with household income less than $30,000 report trouble affording prescription drugs and 17% have delayed or not filled a prescription due to cost. Findings supported the policy process by helping craft policy positions aligned with cancer patient preferences, raising public awareness, and communicating to policymakers the impact of policies on cancer. Conclusions: The panel methodology illustrates the impact of policy decisions on cancer patients and survivors. Findings provide an unprecedented level of input to the policy process for cancer patients and survivors.