The Lynx Group

Industry Leaders Look Ahead to a New Administration

December 2020, Vol 11, No 6

Healthcare and biopharmaceutical industry markets were trending positively during the immediate aftermath of the 2020 election, even before the promising news from Pfizer and Moderna regarding their COVID-19 vaccines. At the 10th Annual Summit of the Association for Value-Based Cancer Care (AVBCC) in 2020, 2 industry leaders advised that the industry reaction was likely in response to an expectation of less volatility and more predictability in healthcare in 2021 with what is likely to be divided government.

Predictability in Healthcare

“Presuming a Biden Presidency and a Republican Senate, we can expect more ‘tension in the rope’ favoring incremental reform over broad sweeping changes,” said Stephen J. Ubl, President and Chief Executive Officer, Pharmaceutical Research and Manufacturers of America.

“If we had had a Democratic wave election, we would be having a very different conversation about policies like H.R.3, which would allow the government to set prices for medicines, something we are very much opposed to,” Mr Ubl said.

Matthew Eyles, MS, President and Chief Executive Officer, America’s Health Insurance Plans, agreed.

“Markets hate uncertainty more than just about anything else. Business wants a predictable operating environment so it can invest, innovate, and be successful. Since the passage of the Affordable Care Act [ACA], there has been hyperpoliticization of healthcare. There is the sense that with divided government, it’s likely that there will be more predictability that is not subject to huge swings of the political pendulum,” Mr Eyles explained.

AVBCC Co-Founder Burt Zweigenhaft, PhD, DLitt, asked whether there were any industry concerns about a Biden administration using executive orders to pass regulations and address drug pricing, but Mr Ubl believes that would not be a major issue.

“We think the election outcomes will demand that the parties work together,” Mr Ubl observed. “The breadbasket of common ground to be pursued is pretty big and includes modernizing Medicare Part D and other pro-patient reforms to lower out-of-pocket costs.”

He added, “Our interactions with then-Vice President Biden were positive. He has personal experience in the cancer space and launched the Cancer Moonshot program, so he has a deep understanding of what it takes, and what a robust biopharmaceutical industry is capable of.”

Keep the ACA

Mr Eyles stressed the importance of the ACA-created marketplaces during the current COVID-19 pandemic.

“We need as many Americans as possible to have healthcare coverage at this time,” he said. Given that many people have lost their jobs, and thus their employer-based insurance, “we would probably see tens of millions of additional Americans lacking coverage right now without the marketplaces. We believe it would be misguided and wrong for the ACA to be overturned, either partially or in its entirety,” Mr Eyles added.

Drug-Prices Reform

Mr Ubl argued that a push for drug pricing reforms that focus on government price-setting or “worse, foreign government price-setting,” which have been proposed by the Trump administration and through the H.R.3 bill, is the wrong way to go.

“We know how that movie ends. Americans have access to about 96% of FDA-approved medications for cancer, while for patients in European countries, it’s about 50%. We are willing to be at the table to reform costs where there are distortions in the system, but we want to make sure that reforms accrue to the benefit of patients,” Mr Ubl argued.

Mr Ubl called for stakeholders, including pharmacy benefit managers (PBMs) and health plans, to focus on misalignments in the system as a starting point to drug-pricing reform.

“Rebates and discounts have grown exponentially, but they’re not making their way to patients; a lot of the fees PBMs and plans charge are based on the list price of medicines, which some believe has led to inflationary pressure,” Mr Ubl said.

“Medicare Part D needs to be modernized to establish an out-of-pocket cap for seniors or to allow them to spread costs across the calendar year, so they don’t have sticker shock early on in the year trying to meet their deductibles. I hope we can find common ground on reforms that are not government price controls, but leverage competition and choice in the marketplace,” Mr Ubl concluded.

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