While the details of value measurement continue to be vigorously debated, nearly unprecedented consensus has emerged over the need to align reimbursement and utilization with value. More controversial, however, is the role of budgetary criteria in determining value and in governing access to health care technologies. The case for adding budgetary tests to measure value [...]
Advances in foundational science, technology, and clinical knowledge are driving a revolution in patient care. At the same time, spending on these innovative drugs and devices has increased dramatically. The question is, what—if anything—should be done to regulate this innovation? To balance physician prescribing of state-of-the-art drugs and patient desires to access them with the [...]
Over the last decade, insurers have increasingly used step therapy or “fail-first,” policies as a strategy to contain pharmaceutical costs. Step therapy requires patients to begin treatment for a medical condition on a typically less expensive drug, and only progress to more costly second-line drugs when the first-line therapy becomes ineffective or inappropriate. Step therapy [...]
This viewpoint, authored by Dr. Chandra, Dr. Shafrin, and Dr. Dhawan, describes the differences between various cancer value frameworks and provides recommendations for improving them for clinicians, patients, and payers. In recent years, novel cancer therapies have improved the expected survival of patients but have also increased treatment costs. As a result of these increases, [...]
In his letter to the editor, IVI's Jeroen Jansen makes the case in Journal of Clinical Oncology that network meta-analysis is the only transparent framework to help answer the treatment selection question, and urges the ASCO Value Framework Task Force to consider this approach when developing their recommendations. Source: Journal of Clinical Oncology
While the rest of the health care system is moving toward paying for value, payments for drugs largely continue to be stuck in a 20th century construct that focuses on price, regardless of the health outcomes of each patient. This lack of payment innovation is particularly damaging in an era where on the horizon new [...]
Medical innovation has generated significant gains in health over the past decades, but these advances have been accompanied by rapid growth in healthcare spending. Faced with a growing number of high-cost but high impact innovations, some have argued to constrain prices for new therapies – especially through global caps on pharmaceutical spending and limits on [...]
Escalating drug prices have alarmed physicians and the American public and led to calls for government price controls. Less visibly, they have also spawned a flurry of private-sector initiatives designed to help physicians, payers, and patients understand the value of new therapies and thus make better choices about their use. Programs recently introduced or advanced [...]
Many patients today are missing out on the benefits of therapies for financial reasons. The problem here is our current model of pharmaceutical pricing, which threatens to deprive patients of current beneficial therapies and other breakthroughs to come. For decades, the vast majority of drug manufacturers and payers have relied on pricing per dose, be [...]
The meaning of "value" varies by each stakeholder and is thereore the least well understood. Drs. Chandra and Goldman discuss that the right way to think about value in health care delivery is a stream of benefits accrued over a lifetime that is attractive relative to the price paid to acquire them. Using examples with [...]
