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The Academy of Managed Care Pharmacy (AMCP) Nexus 2019

Dr Jane Barlow Discusses Paying for Novel, High-Cost Therapies

New high-cost therapies require new financing mechanisms, but the challenge is coming to an agreement on what should be considered in these new payment models, said Jane Barlow, MD, MPH, MBA, executive vice president and chief clinical officer for Real Endpoints.


New high-cost therapies require new financing mechanisms, but the challenge is coming to an agreement on what should be considered in these new payment models, said Jane Barlow, MD, MPH, MBA, EVP and Chief Clinical Officer for Real Endpoints.

Transcript

When coming up with new payment models for high-cost, novel therapies, should the societal benefit be taken into account, and how can that be done?

Yeah, I think that’s a really complex question because the treatments really are made for the benefit of patients and inherent in that is a societal benefit; but the payers often more focus on the cost to the healthcare system. So, those can be misaligned, and part of value-based agreement I think is most successful is one where you can find a solution that is focused on in measuring the value for all the parties; the payers, the patients, and the manufacturers

There are a lot of potential new financing mechanisms being considered or drafted, but what do they need in order to successfully be implemented and adopted?

Well, I think there’s really 2 major obstacles to overcome. So, one is having enough money at risk that those deals are meaningful. Where many of them butt up against barriers is Medicaid best price. So, getting clarification about calculation of Medicaid best price in the situations of value-based payments would be incredibly important.

On the other hand, the burden of the administrative data is one that can’t be ignored and figuring out how to do these deals in a way that the resources are used efficiently is another barrier that needs to be overcome.

 
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