AAN position statement outlines policy proposals for lowering drug costs

The American Academy of Neurology released a position statement that highlights the significant challenges high drug prices create for patients, physicians, health systems and payers.

“People with complex, chronic conditions like Parkinson’s disease, epilepsy and migraine often need specialty drugs that require special handling or administration, and some neurologic drugs, such as those for multiple sclerosis, can be particularly expensive,” Orly Avitzur, MD, MBA, FAAN, president of the AAN, said in a press release. “Drug pricing is a priority for the American Academy of Neurology. We support policy solutions that would allow for price negotiation and transparency to ensure that prescription medications are accessible for patients with complex, chronic neurologic conditions.”

In a position statement published in Neurology, Amy Y. Tsou, MD, MSc, of the ECRI in Pennsylvania and a member of the AAN, and colleagues emphasized that high drug costs hinder access to treatment for patients without insurance, as well as for those with high out-of-pocket costs or plans that do not cover high-cost treatments. Effects of the COVID-19 pandemic, such as job loss and related insurance loss, have worsened existing disparities in health care access.

According to the authors, financial concerns may lead patients to ration medications as a way of saving money, and this decision can pose risks that include death. Further, drug prices in the U.S. are higher compared with those of other countries, with U.S. pharmaceutical companies having had protections that limit competition and negotiation.

Possible policies that may reduce drug costs include further work from the FDA to speed up approval of generic equivalent drugs, which would provide lower-cost options for certain drugs, according to the authors.

They also noted that Medicare could be allowed to negotiate drug prices, which is a strategy with significant support among Americans. Other options include benchmarking Medicare prices against those in other countries and value-based pricing for drugs.

“Neurologists should be cognizant of the cost and inherent tradeoffs involved in ordering diagnostic tests, treatment or medication,” Tsou and colleagues wrote. “If medically necessary, diagnostic and therapeutic interventions should be considered regardless of cost. However, given the many constraints we practice under, it might sometimes be easier to simply acquiesce to the request for ‘another MRI’ or the newest medication for a patient’s neurologic disorder, instead of undertaking the hard work of ascertaining whether it is indicated, explaining this rationale to the patient, and (in either scenario) ensuring the underlying concerns prompting the request are addressed.”

References:

AAN issues ethics position statement on costly drugs and health care. https://www.aan.com/PressRoom/Home/PressRelease/4928. Published Oct. 4, 2021. Accessed Oct. 14, 2021.