It's time to return the serve on extreme Rx pricing

Returning a serve is quite possibly one of the most important shots in tennis. You may not have control over the location, trajectory or speed of the ball coming from your opponent, but there are some things you can do to take control of the game. This analogy easily can be applied to the pharmacy benefits arena. 

As specialty drugs, treatments and prescription medications continue to increase in cost, brokers and advisers have worked hard to create solutions for employers and their employees. Recently, pharmaceutical companies have continued to raise prices and responded by making significant changes to manufacturer assistance programs, which make plan success more difficult to achieve. Now is the time to return the ball and change the course of the game. 

Many people are struggling to afford essential medications that fight infection, decrease inflammation or treat life-threatening conditions. A recent KFF survey shows slightly more than 30% of people have not taken prescription medication as prescribed due to the cost. Some even decline needed prescriptions or ration doses, a practice that could have devastating health consequences. 

Read more: How this company is guaranteeing the lowest drug prices

Others may have treatments that are out of reach. While gene therapy drugs have shown varying efficacy in treating various conditions, including rare diseases, they can come with costly price tags. For example, Zynteglo, a stem cell-based gene therapy used to treat a genetic blood disorder, helped prevent blood transfusions in nine out of 10 people over 12 months in clinical trials. Now here's the rub: It comes at a list price of $2.8 million, placing it on the top 5 most expensive medications in the U.S. Hemgenix comes in at No. 1 with a cost of about $3.5 million — per dose!

A big part of the pharmaceutical industry is researching, producing and marketing drugs used to treat medical conditions. The R&D tax credit, introduced in 1981 to stimulate innovation within American businesses and encourage investment within the U.S., provides subsidies to companies that attempt to innovate and grow. Pharmaceutical companies can apply for these tax credits to help fund research and development efforts, yet medications are still priced exceedingly high. 

Also, under current law, tax deductions are granted for pharmaceutical company's marketing and advertising expenses. A study from the JAMA Network found that medical marketing expanded substantially and spending increased to $29.9 billion in 2016 from $17.7 in 1997. The biggest culprit was direct-to-consumer advertising for prescription drugs and health services, which increased more than 450%.

Read more: Is the pharmaceutical industry due for change?

In that same period, drug company advertising soared to 4.6 million ads from 79,000 ads, a staggering increase. Direct-to-consumer advertising may encourage people to ask for medications they don't need. A recent JAMA Network reports marketing targeted directly toward consumers "is associated with increased patient requests and increased clinician prescriptions for advertised products." Increased demand for medications through advertising could create generous returns for pharmaceutical companies — especially if those prices are increased.

It's time to adjust the racket and change the trajectory of the ball.

No single consultant or agency has the ability to solve healthcare problems alone. There is a call for brokers and advisers to work together. By combining knowledge, expertise and skills, more can be accomplished. Whether your voice is fighting for generic drugs to be approved quicker by the FDA or addressing the lack of clarity surrounding pharmacy benefits managers, you could help the millions of Americans who require medication for chronic conditions or rare diseases.

Managing any change comes with a strong strategy. Changing the focus from disease management to preventative promotion could help change how healthcare is managed. It seems that putting someone through a prevention program 10 years ago was expensive, and simply paying for the medication and ensuring compliance was cheaper. This created a system focused on treating illness instead of promoting health. Today, preventative efforts could produce significant results.

Read more: How much longer can employers endure rising healthcare costs?

A study from the Centers for Disease Control and Prevention shows that sending community health workers into a patient's home to help manage and reduce the environmental triggers of asthma not only reduced costs, but also improved health outcomes for pediatric patients. Introducing and improving workplace wellness programs can contribute to overall health and well-being and help reduce the amount of medication needed later in life.  

Pharmaceutical companies have a loud voice. Ours needs to be louder! Using pooled resources, expertise and a wide range of perspectives, brokers and advisers who are in a position to create meaningful change can create a louder voice. We must do what we can to combat high pharmaceutical costs because the current price of life-changing medications is not sustainable.

This is not a call to stop innovation. It's an attempt to make it fair and affordable for the American public. Most producers, business owners and scientists agree: the main goal is to provide treatments and medications for those suffering from complex, rare and chronic conditions.

Change can be messy and challenging — but it is necessary to reshape the future. In the game of tennis, returning a serve is one of the hardest shots to get back onto the court. Right now, the ball is in our court, and we need to step in and send it back in a way that will create a significant impact.