A new survey finds the majority of Americans fear rising drug costs due to COVID-19; meanwhile, a separate new poll underscores the important role that PBMs play in helping better manage costs; data points to crucial missed opportunities in regards to Medicaid expansion; and, the continued corporatization of hospitals causes increasing alarm.


Coronavirus Rx Costs: According to the results of a new survey, the vast majority of Americans are worried about rising drug costs as a result of the coronavirus crisis.  Conducted by West Health and Gallup, nearly nine-in-ten U.S. adults surveyed said they were either “very” (55 percent) or “somewhat” (33 percent) concerned that the pharmaceutical industry will exploit the COVID-19 pandemic to jack up drug prices.  Additionally, 84 percent also expressed similar concern that the general cost of care will go up as a result of coronavirus.  Stakeholders have seized upon the survey results, pointing out drugmakers’ track record of escalating drug prices with little to no consideration of how those increases impact consumers, and calling on the pharmaceutical industry to suspend its annual summer price hikes during this crisis.

PBMs: Against that backdrop, the vital role that pharmacy benefit managers (PBMs) play in helping control drug costs for consumers has become that much more important.  PBMs are used by employers and health plans to enhance access and reduce costs – both of pressing concern in the wake of COVID-19.  A new employer poll released by the Pharmaceutical Care Management Association (PCMA) reinforces the value that benefits managers and human resource directors place on PBMs’ ability to help their organizations reduce drug costs.  The overwhelming majority (93 percent) reported being “satisfied” with their PBMs – including more than a third who said they were “very satisfied”.  Stakeholders across the pharmaceutical supply and payment chain – including PBMs – have already advanced a set of policy principles aimed at promoting undisrupted patient access to medicines during the pandemic.  Relatedly, with new data pointing to millions of Americans becoming newly eligible for Medicaid this year, PBM’s ability to help states better managing the program’s fiscal sustainability has become an essential component in ensuring Medicaid is available to the vulnerable populations who rely on it for their health coverage.

Medicaid Expansion: A recent study took a look at the impact that failure to expand Medicaid might have had on the states that chose not to grow their programs.  (As a reminder, the Affordable Care Act gave states the option of expanding Medicaid.)  According to the analysis from the Urban Institute, if the remaining “holdout states” had, in fact, expanded Medicaid, an additional 3.9 million people would have been insured this year.  The study goes on to cite additional research providing strong evidence that, in addition to reducing the number of uninsured, Medicaid expansion also led to improved health and reduced mortality in the targeted populations, further reinforcing the importance of the program and making the case for increased expansion to better address the needs exposed by the coronavirus crisis.

Hospitals: The corporatization of health systems continues to dramatically reshape how hospitals operate across the country.  After years of frenetic consolidation, most hospitals now find themselves to be part of much larger systems.  This has led to a growing trend in administration – namely, that many nonprofit hospital systems are increasingly operated like corporations, rather than the charities they promote themselves to be.  Which doesn’t even account for the impact that private equity interests are having on how hospitals are being run now.  As these firms seek to expand their controlling interests in hospitals, ERs, and nursing homes, experts worry that the drive for profits can often run counter to helping patients – fears that are already playing out in rural communities.