By Priscilla VanderVeer

In a recent op-ed published by The Nevada Independent, Nevada Association of Health Plans’ lobbyist Keith Lee argues that Nevadans need access to more affordable medicines.

Mr. Lee is right. Everyone across the health-care system, including the biopharmaceutical industry, needs to do their collective parts to make sure people can afford their medicine. To do so, however, we need to have an honest conversation about what’s really going on when it comes to the cost of medicines. Unfortunately, that is not the conversation Mr. Lee or some of the middlemen he represents – like health insurance companies and pharmacy benefit managers (PBMs) – are interested in having.

It is true that pharmaceutical companies set the list price for medicines. It is also true that companies give back, on average, 40 percent of it as rebates, discounts and other price concessions to other entities in the pharmaceutical supply chain, like insurers and PBMs, for a medicine to be covered. These rebates and discounts exceeded $166 billion in 2018 alone and are growing every year.

And despite the rhetoric you hear, one of the nation’s largest PBMs reported that drug spending grew by only 0.4 percent last year across their commercial plans. This is the lowest commercial drug price trend in 25 years and well below increases in other parts of health care.

But it is also true that it doesn’t feel that way for Nevadans, especially those who are struggling to afford their medicine. Nevadans are not always getting the benefits of rebates and discounts or experiencing the lower growth in spending on medicines.

The reason is that middlemen are shifting more of the costs of health care, especially for medicines, on to patients. At the same time, these companies are reaping the benefits of the ever-expanding rebates, discounts and fees they receive and not always sharing those benefits with patients at the pharmacy counter.

There are policy proposals that could change this, including sharing negotiated discounts with patients at the pharmacy counter. For example, a patient with diabetes who is part of a high deductible health plan that has co-insurance could save nearly $2,000 if the middlemen who negotiates her prescription drug benefit shared some of these savings with her. And depending on the health plan design, it should only affect premiums 1.2 percent or less.

To quote the CEO of OptumRx, a PBM owned by UnitedHealthcare, on what sharing rebates at the point of sale would mean for patients: "Our perspective is in the commercial market the trade off is worth it in terms of the slight increase in premiums but the significant value to consumers.”

Rather than throwing around unproductive rhetoric and pointing fingers, we should take this opportunity to work together across the health-care system and the political spectrum to enact real change for people who cannot afford their medicines. Nevadans deserve at least as much.

Priscilla VanderVeer is a vice president of public affairs at the Pharmaceutical Research and Manufacturers of America (PhRMA).