Is Pharma really hurting from offering financial assistance?

Ah… the war between Pharma and employer health plan sponsors. This article spells out the strategic plays made by both. Although, this WBJ article is a bit of “hit piece” on payors, likely due to Pharma’s advertising leverage with WSJ.?The article paints a picture of Pharma losing revenue, or coming out of pocket, in reaction to payors (health plans) finding ways to leverage programs that PHARMA created.?Pharma is no victim.

The reality:?2020, 2021 and 2022 were record profit years for J&J, Pfizer, and most drug manufacturers (as well as PBMs who broker the drugs).?

The real question.. who’s controlling the price of a drug if we allow essentially perpetual patents (by allowing minor revisions to existing chemical/biologic concoctions, renaming, and approving patents for 10-20 years)?

Here's the WSJ Article:

Patients Lose Access to Free Medicines Amid Spat Between Drugmakers, Health Plans

This battle solidifies the need for healthcare navigators, and companies like SymplBenefits.com:

1. The battlefield is constantly changing (each player is trying to gain an edge).?Patients should not be asked to navigate this and its true “wholesale changes” by plan sponsors can hurt the uninformed. But the same applies for the drug manufacturer. In Mr. Pilker's example, Vertex cut his assistance.
2. This article lacks a ton of context (contracts and formularies, covered, not covered).? Mr. Pilker stated "[he] was scared" when his copay changed.. why? How did his health plan not recognize the change? He's clearly depending on his health plan. And, what notice was provided (by Vertex) for this patient depending on patient assistance?

• NOTE:?Mr. Pilker ultimately received his drug for FREE, from Vertex, within one month.

Why Sympl?

1. We walk patients through the process before health plan changes.?So, the accusations in this article, seeming blaming the plan sponsor for using Rx carve-outs, overlay vendors, and alternative drug sourcing programs. If that's truly what happened... it sounds like Mr. Pilker’s employer’s administrator bumbled the roll-out of this consequential change.?That’s why navigators like Sympl exist.
2. We directly communicate with each member, offering optional incentives, to leverage Patient Assistance, yes... but it's only 1 of 4 Rx sourcing alternates, and more will develop in the future as the battle continues. Why was there no backup supply?
3. Sympl Benefits is also the benefit plan administrator / consultant / agent for our clients. Therefore, same team, same mission, allowing for nimble reaction to a constantly changing battle, while simultaneously supporting the member direct.

It’s about focusing on the individual, and helping EACH MEMBER directly, and CONFIRMING the Rx source is viable before pulling the trigger, and having a backup supplier for lifesaving medications if the manufacturer makes a change like Vertex did.?Again, as you can see in the article, Mr. Pilker got his meds, it was just poorly managed.

Unfortunately, if Pharma (with a giant advertising and lobbying budget) wins these PR battles, and can continue to patent drugs with $100,000+ price tags, employers will not be able to afford these medications.?It’s simply not sustainable.?

I'll leave you with this… the article states:

“The cost of the pharmaceutical companies’ financial-assistance programs ballooned. Drugmakers spent $18.7 billion on copay assistance in 2022, up 29% from $14.5 billion in 2018”

But… here’s the rest of the story:?

2018 - $14.5B (Copay Assistance) vs.?$229B Revenue (Just Top 5 Pharma)

2022 - $18.5B (Copay Assistance) vs.?$358B Revenue (Just Top 5 Pharma)

As a business leader, would you increase assistance 27% ($4B) to improve revenue 56% ($129B)?