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Build back better: US pharma and the future of healthcare

America’s biopharmaceutical industry says it is “ready to do its part” in building a stronger, more resilient, affordable, and equitable health care system for all.

COVID-19 highlighted both the challenges of the US healthcare system and the huge change potential of the country’s pharmaceutical industry.

Now, as vaccination continues at pace, the sector has pledged to help “build back better”, by lowering barriers between medical innovations and the patients who need them.

A new report by PhRMA, which represents the leading biopharmaceutical research companies in the US, said: “COVID-19 has…demonstrated that we need a healthcare system that works better for all patients, and is better prepared for future public health emergencies.

“The substantial challenges faced by states and local public health authorities in testing, treating, and vaccinating Americans during the pandemic highlights key infrastructure gaps in our health care system that need to be addressed.”

In the publication, Building a Better Health Care System: PhRMA’S Patient-Centered Agenda, the organisation says that “common sense, patient-centred reforms” based around three core goals – ending the pandemic; making medicines more affordable; and building a more equitable healthcare system – would “ensure everyone benefits from America’s engine of innovation”.

Ending the pandemic

Bringing an end to the pandemic is everyone’s first order of business, but we also need to prepare for the challenges ahead. That means learning the lessons of the last 18 months, by enhancing supply chain capacity and investing in pandemic preparedness and planning, said the report.

“COVID-19… has demonstrated the critical importance of globally diverse biopharmaceutical manufacturing supply chains to respond to crises and has highlighted the potential negative impacts of nationalistic supply chain policies,” said the authors, adding that biopharmaceutical manufacturers and suppliers had ramped up manufacturing to “unprecedented levels” over the course of the pandemic.

By continuing to foster collaboration, taking steps to address gaps in the science, technology, engineering, and math (STEM) workforce, and policies to incentivise investment in R&D and manufacturing infrastructure, the industry could plug key gaps and be ready for the future, the report said.

“Innovation only makes a difference if what we create can help the people who need it.” 

Facing the next challenge

While the world has been focused on the threat of SARS-CoV-2, the threat posed by antimicrobial resistance (AMR) has been growing.

The problem, which the World Organization (WHO) estimates could kill 10 million people a year by 2050, has been exacerbated during the pandemic.

Doctors, desperate to save hospitalised patients, have used large amounts of antimicrobial medicines. In addition, people on ventilators or with weakened immune systems have been at risk of secondary infections, which has further driven up use of antimicrobials.

The industry must take action, said the report. “Experts around the world agree that, due to the challenging market dynamics, the current pipeline of antimicrobial products to address this growing crisis is insufficient.

“Comprehensive policy solutions are needed to help ensure a sustainable pipeline for new treatment, including advancing payment reforms that remove disincentives for appropriate use of antimicrobial medicines, and creating incentives to promote the development of new antimicrobial treatments and rapid diagnostics.”

Access for all

COVID-19 has brought the US’ health inequalities into sharp focus. And while the country is a world leader in the discovery of new medicine, vaccines and therapeutics, many people face significant challenges accessing and affording quality healthcare.

“Innovation only makes a difference if what we create can help the people who need it,” said the authors.

While recent years have seen an increase in the number of people who are insured, growth in out-of-pocket costs for many people with commercial insurance has outpaced growth in health plan costs, and premiums continue to rise.

“Right now, many of the sickest patients are burdened with most of the costs. Through an endless web of high deductibles, expanded cost sharing, coverage exclusions and narrow formularies, insurers are increasingly standing between patients and the care they need.

“We all need to do better.”

In the document, PhRMA recommends several policy changes. These include capping annual Medicare out-of-pocket expenses, and lowering Part D cost-sharing levels for seniors and people with disabilities.

It also calls for the 340B programme, created to serve as a safety net for low-income and uninsured patients but currently open to abuse, to be reformed and preserved.

“We must pursue policies that preserve 340B for patients that need it through greater oversight and transparency… to ensure that hospitals and other entities are using the discounts to serve needy patients and not siphoning resources away from patients.”

Healthy diversity and inclusion

America’s biopharmaceutical industry “strongly believes that diversity, equity and inclusion are essential to the discovery of new medicines and for access to treatment for people of all ethnic and racial backgrounds”.

“That means taking a more active role through our own actions as an industry, as well as supporting public policies that address health disparities and working together with the broader health care sector to create a more just and equitable healthcare system for everyone.”

The report commits the industry to invest in data and measurement methods, address inequities in the use of medicine, and align incentives with national equity goals.

Crucially, it pledges to expand opportunities for clinical trial participation, and points to the publication, in November last year, of industry-wide principles on clinical trial diversity.

“At the core of these principles is the need for the industry to better serve historically underserved populations. By committing to enhancing diversity in clinical trial populations, we can better reflect the patients that will use the new therapy or medicine being studied and help reduce health care disparities,” said the report.

“The principles seek to build trust and acknowledge past wrongs, reduce barriers to clinical trial access, use real-world data to enhance information on diverse populations beyond product approval and enhance information sharing about diversity and inclusion in clinical trial participation.”

Building back better

The COVID-19 pandemic has highlighted the strengths and the weaknesses of healthcare systems the world over.

It’s now time to take what we have learnt – about the power of collaboration, the importance of preparation, and the need to end health inequalities – and apply it to building back better.

As this report demonstrates, the biopharmaceutical indusyry is ready and willing to play its part in this process.