This document discusses the costs of prescription medicines in the United States. It notes that while new medicines and treatments are improving patient outcomes, prescription drug costs make up a small and stable portion of total health care spending. However, the document also outlines ways that other entities like pharmacy benefit managers, hospitals, and insurers receive an increasing share of spending on brand medicines through rebates, fees, and price markups, shifting more costs onto patients. It calls for reforms to make medicines more affordable and ensure patients benefit from industry savings.
Luca Russo
POLICY SEMINAR
Technical Discussion on the 2019 Global Report on Food Crises: Working together to prevent food crises
Co-Organized by IFPRI, FAO North America and Food Security Information Network (FSIN)
APR 26, 2019 - 09:30 AM TO 11:00 AM EDT
"Overview: Sustainable agriculture production and diversification for healthy...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 1.1: Sustainable agriculture production and diversification for healthy diets"
Luca Russo
POLICY SEMINAR
Technical Discussion on the 2019 Global Report on Food Crises: Working together to prevent food crises
Co-Organized by IFPRI, FAO North America and Food Security Information Network (FSIN)
APR 26, 2019 - 09:30 AM TO 11:00 AM EDT
"Overview: Sustainable agriculture production and diversification for healthy...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 1.1: Sustainable agriculture production and diversification for healthy diets"
Prescription Medicines Costs in Context - June 2019PhRMA
We are in a new era of medicine where breakthrough science is transforming care with innovative treatment approaches and enabling us to more effectively treat chronic disease, the biggest cost driver.
Prescription Medicines - Costs in Context January 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs In Context March 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - August 2018PhRMA
Discussions about the cost and affordability of medicines – and health care more broadly – are important. At the same time, it is important to look at costs across the health care system and not just the share going toward life changing medicines.
Prescription Medicines Costs in Context - June 2019PhRMA
We are in a new era of medicine where breakthrough science is transforming care with innovative treatment approaches and enabling us to more effectively treat chronic disease, the biggest cost driver.
Prescription Medicines - Costs in Context January 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs In Context March 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - August 2018PhRMA
Discussions about the cost and affordability of medicines – and health care more broadly – are important. At the same time, it is important to look at costs across the health care system and not just the share going toward life changing medicines.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - October 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Insulin Costs in ContextPhRMA
A century ago, patients were treated with animal insulins. Today, biopharmaceutical companies produce insulins that operate at the molecular level, more closely resembling insulin released naturally in the body and more effectively managing the disease. The options available today also help meet a wide range of unmet needs, providing patients with the tools necessary to stay adherent and healthy – saving costs throughout the health care system. However, this innovation isn’t enough if patients can’t afford their insulin and other medicines at the pharmacy.
Prescription Medicines: International Costs in ContextPhRMA
Our new Prescription Medicines: International Costs in Context explains how medicines benefit patients, health care systems, and the global economy. Advances in treatment are tacking some of the world’s greatest public health challenges. These treatments provide critical savings for health care systems by reducing the need for more costly services. What’s more is the profound impact that biopharmaceutical companies have on the global economy, including the creation of high-skill jobs, R&D investment, and medicines that improve worker productivity.
2016 Report: Medicines in Development for Alzheimer's DiseasePhRMA
Today, more than 5 million Americans have Alzheimer’s disease. The disease devastates the minds of patients, creates substantial burdens for families and caregivers, and currently costs the health care system more than $200 billion a year. These sobering statistics are projected to get much worse as the 76 million American baby boomers age.
This report shows that America's Biopharmaceutical Research Companies Are Developing More Than 70 Medicines for Alzheimer’s Disease
2015 Report: Medicines in Development for Heart Disease & StrokePhRMA
According to the American Heart Association, someone in the United States dies from cardiovascular disease every 40 seconds, and more than 85 million Americans have at least one form of the disease. Heart disease has been the leading cause of death in the United States since 1921, but these numbers are declining. Read this report by PhRMA - in partnership with the Association of Black Cardiologists - on the nearly 200 medicines in development for heart disease & stroke.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
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- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. 2
We are in a New Era of Medicine Where Breakthrough Science
is Transforming Patient Care
45 new medicines were approved by the FDA in 2022.
Cancer mortality rates continue
to decline amid 'major progress'
in lung cancer early detection
and treatment
Newly approved drug being
called ‘game changer’ for people
who suffer from hemophilia
FDA authorizes new Covid
antibody drug to fight
omicron variant
Cancer Treatments Game Changer Coronavirus Treatments
Source: US FDA. Center for Drug Evaluation and Research (CDER) Advancing Health through Innovation. New Drug Therapy Approvals 2022. & US FDA. Center for Biologics Evaluation and Research (CBER)
Prescription Medicines: Costs in Context www.phrma.org/cost
3. 3
Spending on Medicines Is a Small and Stable Share of Total
Health Care Spending
Prescription medicines
account for just
In 2022, per capita spending
on medicines* grew, below
inflation, at
2.5%
* Excludes spending on COVID-19 vaccines and treatments
Source: Altarum, IQVIA, 2023.
0%
20%
40%
60%
80%
100%
2021 2022 2023 2024 2025 2026 2027 2028
Hundreds
Retail Nonretail* Other health care spending
Projected US Health Care Expenditures Attributable to
Retail and Nonretail Prescription Medicines, 2021-2028
Note: Nonretail prescription medicines are those purchased through physicians’ offices, clinics and hospitals and are typically administered to the patient by the provider. Retail prescription
medicines are those filled at retail pharmacies or through mail service.
Prescription Medicines: Costs in Context www.phrma.org/cost
of total health care spending
14%
4. 4
$0
$1,000
$2,000
$3,000
$4,000
$5,000
Prescription Medicines Other Health Care Cell & Gene Therapy
2021
SOURCES: Young CM et al. Drug Discovery Today, 27(1): 2022.; CMS National Health Expenditures (NHE) Projections, 2022.; Altarum Institute. “Projections of the Non-Retail Prescription Drug Share of National Health Expenditures.” September 2020.
Prescription Medicines: Costs in Context www.phrma.org/cost
2022 2023 2024 2025
Projected Spending on Prescription Medicines, Total Health Care,
and Anticipated Cell & Gene Therapies ($B), 2021-2025
A New Era of Medicine is Not Expected to Impact the Share
of Total Health Care Spending on Medicines
5. 5
Net Prices for Brand Medicines Have Stayed Nearly Flat For
The Past Five Years
0.3%
1.7%
-2.9%
0.9%
0.0%
2018 2019 2020 2021 2022
Average Net Price Growth for Brand Medicines, 2018-2022
On average, a brand
medicine’s net price is
50%
lower than its list price.
Source: IQVIA, 2023.
Prescription Medicines: Costs in Context www.phrma.org/cost
6. 6
Unlike Other Aspects of the Health Care System, Medicine
Costs Decrease Over Time
The price of medicines used to prevent
cardiovascular disease decreased…
…while the cost of the surgical procedure
to treat it increased over a decade.
Source: IQVIA analysis for PhRMA, June 2020.; AHRQ HCUP, July 2020.
Prescription Medicines: Costs in Context www.phrma.org/cost
$2.37
$0.13
-95%
2017
2007
$51,460
$99,859
+94%
2017
2007
7. 7
CONFIDENTIAL
Generic and biosimilar medicines drive significant savings in
the health care system.
Nearly
$2.6 trillion
10-year savings from use of
generic and biosimilars
(2013 - 2022)
91% of All Drugs Dispensed in
the United States are Generics
Looking Ahead, Biosimilar
Savings Projected to Grow
More than 4x
19%
33%
52%
90%
1984 1990 2002 2022
Sources: Drug Channels, AAM, IQVIA.
2018 - 2022
2023 - 2027
$40B
$181B
4.5x
8. 8
The Influence Pharmacy Benefit Managers (PBMs) Have
Over Patient Access and Affordability Continues to Grow
Negotiating power is increasingly concentrated among a small number of PBMs.
Source: Drug Channels Institute, March 2023.
22%
33%
24%
21%
Top 3 PBMs’
Market Share:
79%
OptumRx (UnitedHealthGroup)
CVS Caremark
Express Scripts
All Other
Insurers & PBMs determine:
IF MEDICINE IS COVERED
on the formulary
PATIENT OUT-OF-POCKET COST
based on tier placement
ACCESS BARRIERS
like prior authorization or fail first
PROVIDER INCENTIVES
through preferred treatment guidelines and
pathways
Prescription Medicines: Costs in Context www.phrma.org/cost
9. 9
The Majority of Brand Medicines Face Generic and
Brand Competition
More than 99% of Part D spending in 2019 was for medicines with competition
Class analysis is based on USP classification system. Part D plans are generally required to cover two medicines per USP class, and CMS uses USP to review Part D plan formularies to ensure plans meet formulary standards.
Source: Avalere, 2022.
Prescription Medicines: Costs in Context www.phrma.org/cost
29%
63%
8%
<0.001%
Generics, and brands that have generic versions
Brands without their own generic but in classes
that include generics
Brands in classes with competing brands (but no generics)
Brand medicines alone in their class
10. 10
More than Half of Every Dollar Spent on Brand Medicines
Goes to Entities Who Did Not Develop Them
Prescription Medicines: Costs in Context www.phrma.org/cost
Other Entity Received
Brand Manufacturer
Source: Berkley Research Group, 2022.
11. 11
Insurers, PBMs And Others Receive An Increasing Share Of
Total Spending On Brand Medicines
Total Brand Medicine Spending ($B)
2013-2020
Total Brand Medicine Spending
Received by Payers ($B)
Payers include health plans, PBMs, federal and state governments, and employers
$50.3
$141.1
2013 2020
180% increase
Prescription Medicines: Costs in Context www.phrma.org/cost
Source: Berkley Research Group, 2022.
12. 12
Middlemen are Shifting Costs to Patients Through
Coinsurance and Deductibles
Prescription Medicines: Costs in Context www.phrma.org/cost
More than half of commercially
insured patients’ out-of-pocket
spending for brand medicines
is based on the full list price
39.7%
44.8%
15.5%
60%
Copay
Deductible
Coinsurance
Source: IQVIA, August 2020. Fein A, March 2023.
In 2022, rebates, discounts and other payments made by brand manufacturers reached
$256B, but insurers and PBMs do not always share these savings directly with patients.
13. 13
Patients Face Higher Out-of-Pocket Costs at the Pharmacy
Counter than Other Parts of the Health Care System
Source: Drug Channels Institute analysis of National Health Expenditure Accounts, Office of the Actuary in the Centers for Medicare & Medicaid Services, December 2021. Outpatient prescription drug figures exclude
inpatient prescription drug spending within hospitals and nearly all provider-administered outpatient drugs. Figures in billions.
Prescription Medicines: Costs in Context www.phrma.org/cost
Total U.S. Spending
Hospital Care Retail Prescription Drugs
$1,270B
$348B
Total Patient Out-of-Pocket Spending
Hospital Care Retail Prescription Drugs
$47B
$33B
Total hospital spending is much higher
than total prescription drug spending
Yet, total patient spending on medicines
is more than on hospital care
14. 14
Hospitals Account for 1/3 of All U.S. Health Care Spending and
Contribute to Patient Costs by Marking Up Medicines
Hospitals that mark up the cost of medicines can make more from administering
a medicine than the pharmaceutical company that manufactured it.
250%
The average amount
hospitals mark up the cost
of medicines for patients
with commercial insurance
The amount 340B hospitals
receive for administering
medicines to commercially
insured patients is
than what they paid to
acquire the medicines
3x more
634%
Amount some hospitals
mark up the cost of
oncology medicines
Prescription Medicines: Costs in Context www.phrma.org/cost
Source: STAT, 2021. Source: Milliman, 2019.
15. 15
Brand Medicine Spending Retained by Hospitals and Other
Providers From the 340B Program Grew 12x Since 2013
Source: Berkeley Research Group.
Prescription Medicines: Costs in Context www.phrma.org/cost
12x
16. 16
More Medicines are Available to U.S. Patients as Compared
with Other Countries that Set Prices Artificially Low
The 5-year survival rate for all cancers is 42% higher for men and 15% higher for
women in the U.S. than in Europe.
Source: PhRMA analysis of IQVIA MIDAS® and country regulatory data. October 2022.
Note: New active substances approved by FDA, EMA and/or PMDA and first launched in any country between January 1, 2011, and December 31, 2020. Many launched medicines are subject to additional government coverage restrictions.
Prescription Medicines: Costs in Context www.phrma.org/cost
85%
61% 59%
52% 51%
45%
34%
United States Germany United Kingdom France Japan Canada Australia
Number of New Medicines Available by Country, 2012-2022
17. 17
PhRMA Created the Medicine Assistance Tool, or MAT,
To Help Patients Navigate Medicine Affordability
MAT makes it easier for those struggling to afford their medicines to find and learn
more about various programs that can make prescription medicines more affordable.
Prescription Medicines: Costs in Context www.phrma.org/cost
A search engine to connect patients with
900+
assistance programs offered by
biopharmaceutical companies, including
some free or nearly free options
Resources to help patients
navigate their insurance coverage
Links to biopharmaceutical
company websites where
information about the cost of a
prescription medicine is available
The Medicine Assistance Tool Includes:
18. 18
Making sure patients share in the savings our industry provides
Common-sense, Patient-centered Reforms to Make
Medicines More Affordable
Capping what seniors pay out of pocket for medicines
Addressing insurance practices that restrict access to care
Strengthening safety-net programs to ensure they deliver the support
vulnerable patients need
Learn more at phrma.org/betterway
Prescription Medicines: Costs in Context www.phrma.org/cost