Opinion: Support Health Equity and Access to Health Care With More Affordable Treatment Options

There are many social determinants of overall health. These can include societal and economic opportunities and stability, the resources and support we have in our homes and communities, the quality of our education and housing, and our access to healthy food and green spaces. Inequities in any of these or other social determinants of health contribute to disparities, leading to a burden of disease disproportionately affecting certain people and communities.

As our country continues the important racial justice conversations underway, I believe it’s more important than ever to draw awareness to the disproportionate burden of disease that minority racial and ethnic populations experience in the United States, which has only been exacerbated by the COVID-19 pandemic.

This is a pivotal moment for us all—including pharmaceutical companies, policymakers, providers, payers, and patient advocacy groups—to have honest and productive conversations about how we can play a role in achieving more equitable health outcomes.

In 2020, COVID-19 was the third-leading cause of death, following only behind cardiovascular disease and cancer. The rate of death was highest among African American and Native American or Alaska Native persons, in part because members of these racial and ethnic groups are more likely to encounter barriers to getting care, including lack of health insurance and limited access to important medicines they need. Data demonstrate that more affordable generic and biosimilar medicines can be part of the solution to help break down some barriers and support patients in maintaining their health.

Increasing Access to Affordable Treatment Options

As the total cost of health care continues to steadily rise, Americans should not be forced to choose between their health and other necessities. However, this is the unfair reality for many across the United States. Low-income workers, who are disproportionately persons of color or underinsured, often face difficult choices to maintain their health or access treatment when they do get sick. As of 2019, 20.0% of Hispanic people and 11.4% of African Americans between the ages of 18 and 64 were uninsured, compared with less than 8.0% of non-Hispanic White adults.

In 2019, US health care spending reached $3.8 trillion, with the largest contributors being out-of-pocket costs for medicine and health care visits, Medicare and Medicaid, and private health coverage. Generics have done their part over the last 10 years to decrease this large spend; in fact, generics delivered savings of nearly $2.2 trillion in the United States, and researchers predict biosimilar medicines could save $100 billion from 2020 to 2024. As seen in Europe, these savings can be reinvested in the health care system to improve patient care by increasing hospital staff, shortening patient wait times, and simplifying administrative processes.

Generic treatments are available for a wide range of diseases and disorders and can reduce patients’ out-of-pocket costs, which in turn can enable them to stay on their critical medicines. Biosimilars are FDA-approved biologic medicines that are just as safe and effective as the biologics they reference and provide an opportunity to expand access and generate savings for patients. According to a recent study in the National Center for Biotechnology Information (NCBI), access to biologic treatments is particularly poor in low-income countries in Europe, and the availability of biosimilars has helped to reduce access inequities across various immune-mediated inflammatory diseases. Similar success has been proven for patients with cancer in the United States.

In fact, a recent study shows that African Americans have the highest death rate and lowest survival rate of any racial or ethnic group for most cancers. As the study notes, this is largely because of lower socioeconomic status, which can create barriers to high-quality health care. The multiple biosimilars and generics now available across various cancer types can help lower the costs of cancer care for patients.

With the right mix of stakeholder involvement among government policymakers, regulators, businesspeople, and patients, we can advance policies that increase patient access to treatments and improve health outcomes.

Supporting Access With Policy Solutions

Advocating for legislation and programs that support access to generic and biosimilar medicines can help reduce disparities and improve patient access. Several worthy policies and programs can make health care more equitable, and it will take a combination to make a measurable difference. Adoption of focused, common sense federal and state policies may be the prescription to ensure the sustainability of the biosimilar and generic medicines markets and access to medicines that patients need.

• Policy makers should authorize a temporary add-on payment in Medicare Part B to increase health care providers’ utilization of biosimilars. Under the current system, health care providers are incentivized to prescribe the most expensive options.
• Medicare Advantage and Part D plans need further regulatory guidance from the Centers for Medicare and Medicaid Services to encourage greater coverage of biosimilars on formularies.
• Policy makers should also update Medicare Part D to ensure that generic medicines may be substituted for the reference medicines on formularies at launch with lower cost sharing.
• Policy makers should remove pharmacy benefit manager rebate walls to prevent companies from engaging in pay-to-delay agreements and remove regulatory barriers, thus increasing generic options.
• Policy makers should repeal the Medicaid Generics Penalty, which threatens to force generic manufacturers out of the marketplace and reduce patient access to affordable generic medicines.

Supporting comprehensive education and awareness efforts about treatment options will also go a long way to reduce inequities and empower patients to make the best decisions based on their health care needs. Recently, Congress approved the Advancing Education on Biosimilars Act, which is intended to improve patient and provider awareness of the benefits of biosimilars. Legislation has also been introduced to fix the inflation penalty for generic medicines, which, if passed, will help ensure the sustainability of the generic market.

These are steps in the right direction, but more can be done. Together, we must advocate for sustainable change to support healthy communities for all.