Putting the Best Meds Within Reach for Everyone

Be careful what you wish for, says the wisdom of the ages. It’s all about unintended consequences. Right now, policymakers all over the political spectrum are wishing to solve the problem of drug pricing in the U.S. The simple fact is that drug pricing in the U.S. puts the best, most innovative drugs out of reach for the overwhelming majority of patients. This is certainly true for obesity. But it’s also true for the related disease of  diabetes.

Efforts to fix this problem have a way of backfiring. In the example of pharmacy benefit managers (PBMs), it appears that they can serve to drive prices up. And now, there’s a compelling argument that legislation to put a cost cap on insulin might help folks who depend only on that drug – but at the same time put the best drugs for treating type 2 diabetes further out of reach. These are drugs that can also be used for obesity care.

Innovative Drugs Out of Reach

Writing in the Atlantic, Michael Rose says lowering the cost of insulin could be deadly for some of his patients. That’s because newer, better drugs for type two diabetes are priced so high – prices that this legislation won’t touch – that most patients can’t get them. He explains:

“Because SGLT2 inhibitors and GLP-1 receptor agonists remain under patent protections, drug companies can charge exorbitant rates for them: hundreds if not thousands of dollars a month, sometimes even more than insulin.

“Doctors spend hours completing arduous paperwork in the hopes of persuading insurers to help our patients, but we’re frequently denied anyway. And even when we do succeed, many patients are left with painful co-payments and deductibles. The most maddening part is that despite their substantial up-front expense, these medications are quite cost-effective in the long run because they prevent pricey complications down the road.”

Putting a cap on the price of insulin will be good, but it will create even greater incentives for restricting access to newer life-saving drugs like the GLP-1 agonists used for both diabetes and obesity.

A Broken System

Clearly we have a broken system for drug pricing. It’s part of the broken of U.S. healthcare system that does a poor job of delivering value for the money we spend on it. Innovation brings higher costs in healthcare – almost always. New drugs in the U.S. this year are are coming in at record-high prices. High costs drive payers to limit access to innovation. In turn, those limits on access tend to drive prices even higher. Drug companies have to make their money from the small number of patients who can afford their innovation.

Innovation for the Masses

By contrast in digital technology, innovation has served to lower costs. All over the world, most people are walking around with more computing power in a phone than the computers that landed astronauts on the moon half a century ago. This scale means that innovation got cheaper and better over time. Because tech companies are making a bundle on innovation for the masses.

But right now, healthcare innovation is within reach for only a few who can afford sky-high prices. What if the best meds were within reach for everyone who needs them? What if we move to healthcare innovation for the masses?

Click here for Rose’s essay on the insulin price cap, here for more on the dubious influence of PBMs on prices, and here for the more on the chicken-and-egg relationship between access and costs.

Tantalus and Sisyphus in Hades, painting by August Theodor Kaselowsky / Wikimedia Commons

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September 9, 2022