About Us
The Ensuring Access through Collaborative Health (EACH) and Patient Inclusion Council (PIC) is a two-part coalition that unites patient organizations and allied groups (EACH), as well as patients and caregivers (PIC), to advocate for drug affordability policies that benefit patients.
Our focus is on state level Prescription Drug Affordability Boards (PDABs) and the Centers for Medicare and Medicaid Services (CMS) Inflation Reduction Act (IRA) drug price negotiations.
Putting Patients First
Advocating for Healthcare Policies that Prioritize Patient Perspectives
Unite national and state patient organizations and allied groups (EACH) and patients and caregivers (PIC) to advocate for treatment affordability policies that consider patient needs first.
Educate stakeholders on drug affordability reviews and opportunities to participate in the process.
Facilitate collaboration between decision-makers and coalition members to form alliances and improve outcomes.
Ensure actions of regulators and boards do not unintentionally endanger access to existing therapies or impede the innovation of new treatments.
What are the Issues?
Due to an increased focus on the rising costs of prescription medications, government bodies are carrying out price-driven reviews of specific medications. These efforts are currently underway at the Centers for Medicare and Medicaid Services (CMS) at the federal level and Prescription Drug Affordability Boards (PDABs) in several states. These organizations are tasked with analyzing the costs of a handful of medications and, in some cases, are empowered to change how those drugs are priced within specific insurance programs.
While we advocate for lower patient costs, we are concerned that the price-based reviews of only a small number of drugs could lead to unintended consequences.
We are concerned that...
Opportunities for patient input are limited to short comment periods, too formal for most patients to feel comfortable engaging, or simply asking the wrong questions and thus not discovering or resolving real patient issues.
Patient costs and affordability are not the primary focus of many of the ongoing drug reviews. Some entities consider affordability for patients, others for the state/country, some consider both, and others also include the greater healthcare system, including insurance companies.
The narrow focus of these reviews precludes these authorities from considering and addressing other factors in the health marketplace that contribute to higher patient costs. Addressing known healthcare problems would more directly and effectively benefit patients.
- Altering the payment structure for individual drugs could cause insurers to reevaluate the affected drug, as well as others in the class. This evaluation could result in changes to formularies, the implementation of step therapy, non-medical switching, or other utilization management measures.
- Decreasing payments could also impact the physicians or pharmacies that administer drugs to patients. If payments are set lower than what it costs to administer the drug, physicians could face a financial loss to provide that treatment to patients.
Working Principles
Patient Voices Must Be Involved in Policies Addressing Treatment Affordability Challenges
Lived experience is foundational to identifying affordability challenges and, in turn, making effective health policy decisions. Therefore, it is critical that any health policy discussion or associated process include patient and caregiver perspectives, as well as patient organizations who have an understanding of the life cycle of disease from the lens of prevention, diagnosis, and disease management.
Identify and Resolve Patient-Reported Obstacles to Care
Regulators should focus on identifying and addressing patient-reported obstacles to drug affordability. Failing to resolve the underlying factors that lead to higher costs for patients can result in short-term relief and uneven benefits – aiding some but potentially leaving others with higher costs and drug accessibility challenges. Additionally, regulators should clearly define cost-saving targets, including what percentage will be patients and what will be the state or the broader healthcare system.
Protect Patient Access, Recognizing Potential for Costly Tradeoffs
PDABs and regulators should use their mandate to engage stakeholders and fully examine ways that setting prices or upper payment limits could impact patients. Specifically, if measures to limit drug prices are found to decrease access to drugs, limit patient treatment options, or lead to increased utilization management, then they should be rejected. Regulators must work with patients, caregivers, as well as patient organizations and allied groups, to understand the full breadth of issues that could impact their care. Solutions should improve quality of life and reduce costly adverse events, not impose more obstacles to safe and effective drugs that could keep patients healthier and less reliant on other high-cost or emergency care.
Safeguard New and Novel Treatments
Scientific advancements and health research are increasing the availability of precision medicine, gene therapies, and novel treatments. While these new approaches and treatments may also come with high prices, they may also change the lives of patients who have long been waiting for hope, potentially ushering in a new era of innovation in healthcare. Policies that cap prices or establish upper payment limits without recognizing the value and importance of these advances for patients’ quality of life could disincentivize medical innovation and investment into critical new cures for patients.
Meet the Leadership
Founder
Tiffany Westrich-Robertson
As both a patient and advocate, Tiffany understands the unique perspective that patients have on healthcare issues and the importance of bringing everyone to the table with decision-makers. She started EACH/PIC with that idea and purpose.
Coalition Administrator
Desirée M. Richmond
Desiree is the backbone of the coalition, keeping calendars, members and staff all running smoothly. If you need something, odds are Desiree can help.
Patient Advocacy Manager
Brian DuVal
Brian is a long-time health policy advocate, as well as patient and caregiver. Brian brings his own experience advocating for patient-first policies to the coalition, focusing on helping patients and caregivers participating in the PIC.
About the Coalition National Network
The EACH/PIC Coalition, made up of patient organizations, allied groups, patients, and caregivers, aims to be a primary resource of information to help policymakers and advocates alike navigate the government drug affordability review process and address real patient issues.
We implement a “National Network” philosophy, where participants who are active at state or national levels are encouraged to lead updates and share their resources to increase our impact.
