Other factors affecting US health care reform

Although biosimilar uptake may reduce health care costs while improving access and quality of care, other factors will also influence the future of health care reform in the USA, most notably ongoing policy discussions regarding the future of the ACA under the current administration. In the broadest sense, the economic environment may impact health care costs.13 In past economic slowdowns, spending on new and expensive technologies, particularly those with uncertain benefits, was scaled back.14 These reductions occurred even before ACA cost initiatives changed perceptions and spending behavior by highlighting the importance of health care cost.3 Social factors such as disparities in income, education, and health literacy also have a considerable impact on health care utilization (eg, using the emergency department in lieu of primary care or foregoing preventive care) and outcomes, which in turn affect costs.

Kaiser Health News reports that hospital mergers, provider consolidation, and insufficient competition in the exchange market may drive up health care costs.59 Many hospitals are joining forces and purchasing physician practices as they gear up to become integrated systems, leaving fewer independent hospitals and doctors.59 With the greater market share gained by these health systems as they consolidate, their leverage in negotiations with insurers grows and may result in increased prices as well as limited patient choice. Insufficient competition exists between exchange plans due to mergers and tax breaks on employer-provided plans.14 The increase in deductibles and copays may also affect health care costs.14 Large out-of-pocket cost exposure and inadequate subsidies mean middle-class households face substantial and uncertain costs with exchange plans, as subsidies are focused on those with low income.16

Better solutions are required to address rising health care costs and future demand.14,60 Negotiating drug prices and discounts is a good solution in theory, but more difficult in practice, and a universal “value” framework for drug reimbursement and adoption is still needed.14 There is a need for Medicare to increase value payments and optimize value utilization.3 For specialty drugs, stakeholders, including payers and providers, have implemented innovative strategies to ensure appropriate utilization and management; these will continue along with health care reform practices.60 However, drug spend is just one aspect of health care costs,14 and complementary strategies, including correctly identifying opportunities for containing other rising costs and value improvement, are required.3

CONCLUSION

The ACA has partly achieved some of its triple aims of increasing health coverage, reducing costs, and improving quality of care. However, the opportunity remains to change the way health care is administered to achieve fully the aims of health care reform. Although the future is uncertain, given administrative changes, the increased use of biosimilars in the US health care system could enable stakeholders to better achieve expanded access, reduce costs, and improve the quality of care.

Acknowledgments

Medical writing support was provided by Jennifer Priaulx and Karen Smoyer of Engage Scientific Solutions. This review was funded and sponsored by Pfizer Inc.

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

Ralph Boccia has received payment from Pfizer Inc. and from Sandoz to serve on advisory boards for their biosimilar platforms. Gilberto de Lima Lopes Jr reports personal fees from Pfizer Inc. and grants and personal fees from Fresenius Kabi and Sandoz. Ira Jacobs and Robert Popovian are employees and stockholders of Pfizer Inc. The authors report no other conflicts of interest in this work.


Ralph Boccia,1 Ira Jacobs,2 Robert Popovian,3 Gilberto de Lima Lopes Jr4

1Center for Cancers and Blood Disorders, Bethesda, MD, 2Global Medical Affairs, Pfizer Inc., New York, NY, 3US Government Relations, Pfizer Inc., Washington, DC, 4Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA 


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