Did the administration consider the importance of blood clot medicines to patients in the price setting process

We've discussed how the Inflation Reduction Act's (IRA) price setting policies are putting at risk research and development of new medicines for diabetes and autoimmune diseases. Today, we look at the impact of government price setting on patients who rely on medicines that prevent and treat life-threatening blood clots.

Anticoagulants are a vital tool that providers and patients rely on to prevent and treat blood clots and reduce the risk of serious conditions like heart disease and stroke. Two anticoagulants are subject to government price setting in 2026. These medicines come from a newer class of direct oral anticoagulants - known as DOACs - which significantly reduced treatment burden for the 4.5 million seniors who rely on this class of treatments.

The impact: Approximately 100,000 people die of blood clots each year, according to the National Blood Clot Association (NBCA) Advocacy Institute. As the NBCA notes, "blood clots do not discriminate." They can impact anyone at any time, with numerous risk factors that include hospitalization, pregnancy, trauma, obesity and smoking.

How far the industry has come: A competitive market-based system for prescription medicines encouraged the development of range of DOACs for blood clotting disorders to meet different patient needs. As co-occurring chronic conditions are common among these patients, treatment choice is often guided by the presence of these conditions to mitigate certain risks and adverse health outcomes. Likewise, having a range of treatments available to patients in this class is remarkably valuable. In 2019, clinical practice guidelines were updated recommending their use over prior treatments because these medicines showed increased efficacy in preventing strokes and other negative health outcomes, while avoiding monthly blood test monitoring.

Access to blood clot treatments makes a difference:

• Annual health care costs for cardiovascular conditions are projected to increase by 54% from $234 billion to $361 billion. Stroke is projected to account for the largest increase in these costs, highlighting the importance of medications like anticoagulants that prevent strokes.
• Better prevention and treatment of cardiovascular disease can further help control health care costs. For example, one study found roughly half of the marked slowdown in Medicare spending growth between 1999 and 2012 was the result of slower growth in spending on cardiovascular diseases. Use of cardiovascular medicines accounted for one-quarter of the overall slowdown in medical care spending over this period.

IRA threatens the progress on the horizon: Substituting government intervention for market competition comes at a cost. More than a dozen treatments are currently in the research pipeline for blood clotting disorders. Unfortunately, the selection of several DOACs for government price setting puts R&D investments in these types of medicines at risk. As a result, continued progress for patients with a range of cardiovascular conditions that rely on anticoagulants may never reach the patients who need them.

The bottom line: Government price-setting puts progress for treatments and cures for blood clots at risk. While history has demonstrated that increased access to prescription medicines not only improves health but also curbs overall health care spending, price-setting policies enacted under the IRA move our health care system in the opposite direction by discouraging investment in chronic disease medicines, such as those that treat and prevent blood clots and reduce the risk of heart disease and stroke.

Learn more about how price setting can undercut the immense value new medicines provide. And stay tuned for our final installment in this series on blood cancer medicines.

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