“I don’t think we talk enough about the tension between innovation and who pays for the innovation — and who can access it.”
Dr. Vin Gupta, a pulmonologist and chief medical officer at Amazon Pharmacy made this remark during an interview last week at RSNA 2023, the annual radiology and medical imaging conference in Chicago.
He noted that it’s very easy to get caught up in the excitement surrounding innovations in the medical field, such as the new RSV vaccine, novel weight loss drugs and advanced AI tools that help clinicians with diagnosis. But when talking about these new developments, healthcare leaders often fail to address questions about whether these innovations will be covered by insurance and whether all patients will be able to benefit from them.
“There’s a ton of new stuff [at RSNA], and that’s amazing, but ultimately the question is who pays for it? And we continue to see this tension,” Dr. Gupta declared.
Through the improved collection of patient data, payers could be able to make better decisions about which new treatments they will pay for, he said.
He recalled a recent conversation with FDA Commissioner Robert Califf in which Califf emphasized the country’s need to create post-launch patient registries for newly approved drugs. Dr. Gupta thinks this is a good idea, arguing that collecting data on patients who take freshly approved drugs will help payers answer “the many known unknowns.”
For example, when it comes to a newly approved weight loss drug like Eli Lilly’s Zepbound, having a large patient registry would help payers answer questions concerning how long patients need to be on the medication, how their health improves over time and which patients benefit the most, he explained.
“The more that we learn about these really expensive medications — weight loss drugs as one example — through post-launch patient registries, the more it’s going to help payers understand which patients they absolutely need to double down on and make sure they have coverage,” Dr. Gupta said.
Obviously payers’ decisions on whether or not to cover certain treatments affects who can access them, but information asymmetry impacts also patient access. For instance, Dr. Gupta explained that there are plenty of coupons available to help patients afford their expensive insulin medications, but most patients who could benefit from these discounts simply don’t know they exist.
“[Amazon Pharmacy] has saved almost $10 million since the launch of our coupons program back in November of ‘22,” he claimed. “What we’re doing is part of the necessary broader solution — which is if something exists to lower the price of medication that’s branded, you should automate that and surface it in the most frictionless way possible. We’re trying to do that by expanding the program, but it’s a broader issue.”
To illustrate this point, Dr. Gupta cited a recent study showing that while most patients assume getting their medications through their insurance is the cheapest option, this is false in many cases.
The study, conducted by researchers at the University of Toledo, looked at the 20 most commonly prescribed generic medications. It found that 20% of these prescriptions would be less expensive for insured patients if they ordered through Amazon Pharmacy, and 40% would have been cheaper if they used GoodRx.
Companies like Amazon Pharmacy and Mark Cuban Cost Plus Drugs are trying to make generic drugs more cheaply available for consumers, but increasing medication costs in healthcare are largely driven by specialty drugs expenses — and these online pharmacies are only in the beginning stages of addressing specialty drug costs.
Photo: claudenakagawa, Getty Images
