Patients groups have credibility and influence precisely because they ostensibly represent the ordinary people whose fate is in the hands of the health care system, from brain injury survivors to people living with cancer to individuals facing mental health problems.
Now a troubling new report from the corporate watchdog group Public Citizen reveals that some patients groups are accepting donations from the pharmaceutical industry and then siding with it in backing policies that may contribute to higher drug costs for the very patients whose interests they claim to represent.
At issue is the pharmaceutical industry’s efforts to undermine a reform proposed by the Centers for Medicare and Medicaid Services (CMS) that would encourage doctors to prescribe cheaper medications that are equally effective as high-cost drugs. Known as the Medicare Part B demonstration project, the proposal would modify the reimbursement structure for prescription drugs “that are administered in a physician’s office or hospital outpatient department, such as cancer medications, injectables like antibiotics, or eye care treatments,” according to CMS.
“Today, Medicare Part B generally pays physicians and hospital outpatient departments the average sales price of a drug, plus a 6 percent add-on,” CMS explains. “The proposed model would test whether changing the add-on payment to 2.5 percent plus a flat fee payment of $16.80 per drug per day changes prescribing incentives and leads to improved quality and value.”
Public Citizen argues that the proposed reform is a step in the right direction because it “aims to remove incentives for needlessly prescribing high-priced medicines when equally effective and affordable alternatives are available.”
“Today, we pay doctors more when they prescribe higher-priced medicines — and so they do, even when there are affordable equivalents,” said Peter Maybarduk, director of Public Citizen’s Access to Medicines program, in a press statement. “As a result, Americans pay more for health care. We struggle to pay medical bills and resort to dangerous pill-splitting, or even forego our treatments.”
Unsurprisingly, the pharmaceutical industry has come out swinging against the proposal, unleashing a large-scale lobbying offensive at the beginning of the summer.
This is where the patients groups come in. In addition to lobbying efforts from pharmaceutical and physicians groups, 147 patients organizations signed two different letters addressing US Congress and CMS opposing the proposed reform, organized by the Partnership to Improve Patient Care and the Community Oncology Alliance.
“We believe that this type of initiative, implemented without sufficient stakeholder input, will adversely affect the care and treatment of Medicare patients with complex conditions, such as cancer, macular degeneration, hypertension, rheumatoid arthritis, Crohn’s disease and ulcerative colitis, and primary immunodeficiency diseases,” states the COA letter.
According to the Public Citizen report, of the 147 groups that opposed the reform, at least 110 — or three-fourths — receive funding from the pharmaceutical industry.
“Unfortunately, patients’ groups are not required to disclose these conflicts of interest, so this finding is based on voluntary disclosures that patients’ groups and drug companies provide on their websites,” explains Rick Claypool, research director for Public Citizens’ president’s office and author of the report. “As such, they likely under-represent the degree to which patients’ groups receive pharmaceutical industry sponsorship, and how much the group receives from the industry is unknown.”
A separate Public Citizen report released July 11 found that members of the US House of Representatives who oppose the reform received “82 percent more in campaign contributions for the 2016 election cycle than members who did not side with the industry.”
Claypool argues that such donations, at the least, raise questions about the independence of those who accept the funds.