The price of prescription drugs has rapidly increased over the past several years. These price increases have negative impacts throughout the health care system. They not only threaten patient access to drug therapies, but also challenge providers’ abilities to provide the highest quality of care. Drug costs also are a major factor in the rising cost of health care coverage.
Hospitals bear a heavy financial burden when the cost of drugs increases and must make tough choices about how to allocate scarce resources. Managing these rising costs forces difficult choices between providing adequate compensation to employees; upgrading and modernizing facilities; purchasing new technologies to improve care; or paying for drugs, especially when these price increases are not linked to new therapies or improved outcomes for patients.
Impact on Hospitals
In 2016, the Federation of American Hospitals and the American Hospital Association commissioned a study to better understand how drug prices are changing in the inpatient hospital setting. The study found:
- Average annual inpatient drug spending increased by 23.4% between FY2013 and FY2015.
- Inpatient drug spending increased on a per admission basis by 38.7% during the same period.
- Growth in unit price — not volume — was primarily responsible for the increase in total inpatient drug spending.
- Over 90% of surveyed hospitals reported that inpatient drug price increases had a moderate or severe effect on their ability to manage costs.
- Due to delays in refreshing the pharmaceutical index, Medicare reimbursement cannot keep pace with rapidly increasing drug prices.
- The growth in spending on inpatient drugs exceeds the growth in spending on retail drugs.
- Price increases appear to be random, inconsistent and unpredictable: Large unit price increases occurred for both low- and high-volume drugs and for both branded and generic drugs. About half of the drugs sampled had no generic competition.
In 2019, FAH and AHA issued a follow-on study to the 2016 study, examining not only inpatient spending but also the impact on outpatient spending and the impact of drug shortages. The study found:
- Average total drug spending per hospital admission increased by 18.5% between FY2015 and FY2017.
- Outpatient drug spending per adjusted admission increased 28.7%, while inpatient drug spending per admission increased 9.6% during the same period.
- Payers are unable to keep up with rising drug costs; e.g., the growth in expenditures per hospital admission on inpatient drugs exceeded the Medicare reimbursement update five-fold during the study period.
- Hospitals experienced price increases in excess of 80% across different classes of drugs, including those for anesthetics, parenteral solutions, opioid agonists and chemotherapy.
- Over 90% of surveyed hospitals reported having to identify alternative therapies to mitigate the impact of drug price increases and shortages.
- One in four hospitals had to cut staff to mitigate budget pressures.
- Hospitals report that drug shortages put patient care at risk and create additional burden and cost.
FAH is committed to supporting market-based reforms that help combat these rising prices by increasing transparency, promoting competition and innovation, and improving value. As such, FAH is a member of the Campaign for Sustainable Rx Pricing, a group comprising providers, patient organizations and insurers committed to finding solutions to the problem of rising drug prices. More information about CSRxP and solutions to this problem can be found here.
Persistent drug shortages are having an ongoing, negative impact on our patients. They have far-reaching implications including implementation of time-consuming and costly measures to ensure our hospitals continue to provide world-class care.
Managing drug shortages is a continuing struggle for hospitals, impacting patient care, hospital financial health, staffing and information technology requirements. Our hospitals report that drugs in short supply are commonly prescribed, essential products, such as opioid injectables, saline, sodium bicarbonate, sterile water, epinephrine and dextrose.
FAH is a participant in a drug shortage working group comprising leading health care provider organizations — including representatives of hospitals, health-system pharmacists, physicians, group purchasing organizations (GPOs) and other supply chain stakeholders — that convened a series of meetings to develop recommendations and policy proposals to help prevent and address drug shortages.
We believe implementation of the following proposals would help avoid or mitigate the impacts of these persistent shortages:
- Encourage early drug shortage alerts and ongoing multi-stakeholder communications
- Enhance transparency requirements for drug shortage information
- Strengthen drug shortage disclosures
- Develop manufacturer drug shortage action plans
- Better integrate FDA drug shortages list with outside resources
In 2018, seven hospital systems including an FAH member founded Civica Rx to deal with the growing problem of injectable generic drug shortages that were often accompanied by price spikes. Launched as a nonprofit generic drug company, Civica Rx has proven to be a viable industry player, ensuring stable and predictable supplies — manufacturing more than 40 different generic drugs in 2021 and planning to offer more than 100 drugs by 2023.
FAH Letter to Democratic Leaders Outlines Priorities for Budget Reconciliation Package
FAH Sponsors Drug Shortage Briefing on Capitol Hill