The roundtable provides a forum for academic researchers, health policy experts, patient advocates, health insurance plans, and the pharmaceutical industry to debate on the most sustainable strategies for patient cost sharing for medications.
For a second year, The American Journal of Managed Care® (AJMC®) collaborated with the Patient Access Network (PAN) Foundation to provide a forum for academic researchers, health policy experts, patient advocates, health insurance plans, and the pharmaceutical industry to exchange ideas and debate on the most sustainable strategies for patient cost sharing for medications. The event included presentations by winners of case studies and papers that were submitted, a presentation by a patient, and panel discussions. Following is a summary:
1. The outlook for high-need Medicare beneficiaries
Healthcare challenges faced by Medicare beneficiaries may not go away anytime soon, especially if they suffer from multiple comorbidities. That was the takeaway from the presentation by Tricia Neuman, senior vice president of the Henry J. Kaiser Family Foundation and director of the Foundation’s Program of Medicare Policy. This population of patients, many of whom have a low fixed monthly income, needs policy decisions that can lower their cost-sharing burden, particularly the Part D coverage gap also called the “donut hole.”
2. The patient speaks
Melissa Thompson, MBA, is a healthcare strategist, a patient, and a self-advocate. Diagnosed with breast cancer within a few weeks of having a baby, Thompson—an entrepreneur who was enrolled in an exchange plan through the Affordable Care Act—went through months of treatment.
“I had over a million dollars in paid costs last year, now I have a new health plan that says there’s no cap on patient out-of-pocket (OOP) spending,” Thompson said. She emphasized that while value frameworks are a step in the right direction, stakeholders need to find partners in this journey.
3. Case studies and paper challenge winners
While patient education was the theme of the case study presenters, winners of the paper challenge presented data that can influence formulary and health plan design.
Case studies. Veena Shankaran, MD, MS, associate professor, Division of Medical Oncology, University of Washington, discussed an education program created by their hospital to improve patient financial literacy and to connect them with funding organizations. Andrea Baer, MS, and Marcia Baker, MS, Ed, spoke about the peer-to-peer support provided by their organization, Mended Hearts, Inc.
Papers. Kai Yeung, PharmD, PhD, scientific investigator I, Group Health Research Institute, presented his research group’s idea of creating a value-based formulary, where copayments are determined by cost effectiveness analysis. Jalpa A. Doshi, PhD, associate professor of medicine, University of Pennsylvania, presented data that analyzed OOP prescription drug costs for Medicare Part D specialty drug users under existing policy and simulated the impact of recent Medicare Payment Advisory Commission recommendations and her group’s proposed strategies.
4. Panel discusses addressing patients’ financial needs
The case study and paper winners joined Mary Richards, executive director, Partners for Better Care, for a panel discussion on the best way forward to improve the cost burden that patients face. Panelists agreed that patient empowerment is key to initiating these conversations, as is navigation and case management support. As for treatment decision support, Shankaran indicated that physicians could take the lead with making value-based decisions.
5. Strategies for sustained access to medicines
For the final panel of the day, health policy experts joined representatives from 2 trade groups, America’s Health Insurance Plans and Pharmaceutical Research and Manufacturers of America, for a discussion on sustainable strategies that would potentially be a win-win for all. The discussion ranged from manufacturer concerns with high-deductible plans, health plans’ concerns with drug price benchmarks, and policies for a “clinically nuanced” price.
The takeaway message from the discussion, according to moderator Clifford Goodman, PhD, senior vice president, The Lewin Group, was “High-deductible health plans are a barrier to value-based care.”