Getting the 5 Rights Right: Right Drug, Right Price, Right Place, Right Patient Support, Right Data By: Carolyn Pare

“To say, ‘well, this is covered by insurance, so what are people worried about?’ makes no sense. The insurance company doesn’t pay for the drug. The insurance company bills somebody for the drug and pays pharmacies for it. The insurance company just processes transactions.”

Dr. Stephen Schondelmeyer
PBS Newshour, August 29, 2016

The recent price increase on the lifesaving EpiPen — up 400 percent in a decade — outraged patients, parents and lawmakers, igniting a media frenzy and lighting up social media channels. But the CEO of Mylan, the EpiPen manufacturer, deflected blame, pointing the finger at “an outdated health care system that incentivizes higher prices.”

What she failed to acknowledge is that the money coming from insurance companies to pay the steep cost comes from policyholders. Ultimately, increases affect all people, not companies or health care systems. And discount coupons are not the answer because that just redistributes the cost in an inequitable way.

Telling insurance companies they have to pay more toward the cost of unaffordable drugs doesn’t solve anything. Insurance companies aren’t creating money in the basement; they charge consumers — all consumers — whether or not they are taking a particular drug.
This is why The Action Group’s Specialty Pharmacy Action Network members have been hard at work for nearly two years identifying the issues surrounding the high cost of specialty drugs, developing possible solutions, and learning what actions need to be taken to reshape the marketplace. On August 11, 2016, we held a Community Dialogue, bringing together all interested stakeholders to share perspectives, knowledge and ideas about how we can collaborate to develop solutions for getting the 5 rights, right: Right drug, right price, right location, right patient support, right data.

  • View the Community Dialogue presentation here.
  • View the Stakeholder Call to Action here.

Our next step is to form a Guiding Coalition with representatives from employers, pharmacy benefit managers, health plans, specialty pharmacies, provider organizations, and pharmaceutical manufacturers to develop a shared vision and action plan for stabilizing a very broken system. Minnesota needs to continue leading the way in health care innovation, which includes gaining control over the high cost of prescription drugs on behalf of our entire nation and its people.

If you are interested in learning more about the Guiding Coalition, please contact me (cpare@mnhealthactiongroup.org).

Why Getting the 5 Rights, Right Matters:

The example below shows just one condition at one Minnesota employer, illustrating why it’s so important to get the 5 rights right. With MS therapy costs increasing 500% in a decade, just 40 patients cause costs to increase by $51.88 per health plan member, per year, or $2.08 million per year. Now multiply this by countless other conditions requiring lifelong drug therapies.

Multiple Sclerosis and Plan Cost: 2013
Multiple-Sclerosis-Plan-Cost--2013


Carolyn Pare is the President and CEO of the Minnesota Health Action Group.

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