Recommendations Aim to Shape Health Funding, Drug Pricing

February 11, 2019 04:18 pm News Staff – Photographed smiles, bipartisan handshakes, politely shared data. This is the Group of Six convening in Washington to brief lawmakers on what a half-million frontline physicians see on the job, what their patients require and how to improve U.S. health care.

"I have a patient who lost her leg due to her not being able to buy her insulin," AAFP President John Cullen, M.D., of Valdez, Alaska, told reporters Feb. 6 at a press breakfast kicking off a day of meetings with legislators and staff that centered on the recommendations.

His is not an isolated example. The Group of Six's joint recommendations on rising costs and growing shortages of prescription drugs cites a Yale University study that found the typical patient cost of a vial of insulin increased from about $40 in 2002 to $130 in 2013. A story in The New York Times on that finding, also quoted by the group, noted that "a surprisingly large number of people with diabetes are using less insulin than prescribed because of the rising cost of the drug, putting themselves in danger of serious complications." 

Cullen was just as direct when a reporter asked about the social media tumult that followed the National Rifle Association's demand last fall that physicians "stay in their lane" when it comes to firearm-related violence.

Story Highlights

"We all have stories," Cullen said of his and his colleagues' experiences treating firearm-related trauma. "We've all lived through this and know that the worst thing to have to do is tell a parent his child has died. So yeah, this is our lane. It's a public health issue, and we need to address it as such."

That's one of the reasons the Group of Six, in its recommendations on federal funding for public health priorities, calls for $50 million in new funding for CDC research on preventing firearm-related morbidity and mortality.

"The foundation of a public health approach is rigorous research that can accurately quantify and describe the facets of an issue and identify opportunities for reducing its related morbidity and mortality," the recommendation said. The same approach, it added, "should be applied to increasing gun safety and reducing firearm-related injuries and deaths."

Federal Funding Priorities

"We are calling on the White House and Congress to make funding for public health and physician workforce programs a top priority in fiscal year 2020," the organizations said in the recommendations for federal funding.

Quoting CDC data, they noted that 86 percent of the nation's $2.7 trillion annual health care expenditures is spent on people with chronic and mental health conditions. As of 2012, the agency reported, about half of all adults -- 117 million people -- had at least one chronic health condition, and one in four adults had at least two.

Meanwhile, the group wrote, the number of physicians isn't keeping pace with demand. The Association of American Medical Colleges, in research quoted in the recommendation, estimates a potential shortage of more than 100,000 U.S. physicians by 2030.

To meet these difficulties, the Group of Six requested that specific appropriations go to five key agencies:

• $8.75 billion to the Health Resources and Services Administration to support community health centers, workforce training programs and maternal and child health programs;
  
• $7.8 billion to the CDC for work that includes maintaining the Prevention and Public Health Fund and research on preventing firearm-related morbidity and mortality;
  
• $460 million to the Agency for Healthcare Research and Quality for research that affects clinical decision-making, reduces health care costs and medical errors, and increases patient safety;
  
• $41.6 billion to NIH to maintain a steady trajectory of annual increases for the agency and support for research in every state; and
  
• $3.7 billion to CMS to ensure program integrity and support of programs that help consumers make informed decisions about their health insurance coverage.

Prescription Drug Policy

"The rising cost of prescription drugs, combined with shortages of many vital drugs, are creating barriers to patients getting the medications they need to maintain and improve their health," the organizations wrote in the introduction to the recommendations on prescription drugs. They cited broad evidence of unprecedented price increases for newly approved products, as well as for older and generic medications.

According to one source -- an article published online in April 2018 in the Journal of General Internal Medicine and cited in the recommendations -- the prices of 300 off-patent drugs rose by 100 percent or more between 2010 and 2015 -- some by as much as 5,500 percent.

A solution from policymakers, the group said, is imperative.

For guidance, the recommendations included a set of principles centered on "ensuring that every patient has access to the medications that are most effective for their medical conditions, at a cost that they, and the overall health care system, can afford -- including developing solutions to ensure a sufficient supply of drugs to treat patient populations."

The principles aim for goals that include

• manufacturer transparency regarding how a medication's price is affected by research, development and marketing costs, and on price increases for existing drugs;
  
• an examination of industry practices that may inappropriately limit competition, as well as the effects of regulatory agencies, payers and pharmacy benefit managers on competition, value and fair pricing of medications; and
  
• a remedy to the unnecessary administrative burdens placed on physicians by certain formulary practices that interfere with the patient-physician relationship and impede patients' access to needed medications.