Since 2010, John Castellani has served as president and CEO of the Pharmaceutical Research and Manufacturers of America, which represents leading biopharmaceutical researchers and biotechnology companies. Castellani, who began his career as an environmental scientist at General Electric, previously served as CEO of the Business Roundtable and executive vice president of Tenneco. He is a trustee at Sibley Memorial Hospital and a director of the National Health Council. Modern Healthcare reporter Jaimy Lee recently spoke with Castellani about how high-deductible health plans are affecting patients' access to prescription drugs, PhRMA's concerns about the 340B drug discount program and its legislative priorities in Congress this year. This is an edited transcript.
Modern Healthcare: Are there prescription drug-coverage issues that your organization is concerned about?
John Castellani: Our scientists and physicians are taking advantage of unlocking the human genome and providing much more effective, much more personal medicines for patients and meeting a lot of unmet medical needs. At the same time, there continues to be pressure from payers on this very small part of the whole healthcare system. Medicines make up about 10% of total U.S. healthcare spending. What we are seeing, particularly in exchange plans, is a high cost-sharing requirement. A Milliman report showed that silver-tier plans are nearly four times more likely to have a combined deductible for medical and pharmaceutical benefits than an employer plan. This requires patients, particularly lower- and middle-income people, to have tremendous out-of-pocket expenses for the medicines that they need to help avoid much more expensive acute care. We are troubled by that.
MH: Given how drug companies are pricing new drugs, is your organization concerned that insurers will simply stop paying for some of those drugs unless they are considered essential to saving lives?
Castellani: The issue has to be looked at from the patient perspective. Are these medicines that can treat and in some cases cure diseases, and are patients going to have access to them? The discovery process is long, hard and expensive. A recent report from Tufts shows that it costs almost $2.6 billion and takes about 10 to 15 years to develop a single medicine. The Congressional Budget Office has recognized that in the Medicare Part D program, the more that patients have access to medications to manage their diseases, the more Medicare is saving in acute-care costs and long-term-care costs. So the key is to be able to get these innovative medicines to the patients.
MH: Insurers argue that drug companies use coupons and other forms of copay assistance that undermine their pharmacy benefit designs that are meant to encourage people to use lower-cost generics. What is your view of these assistance programs?
Castellani: Manufacturer-sponsored patient-savings programs help patients afford prescription medicines, which play a key role in maintaining health and slowing disease progression. We think they have a positive effect.