Encouraging the use of generics is only one of the ways to manage the rising costs of medications, according to Karen Ignagni, president and CEO of EmblemHealth. Data and system transparency will also help both the patients and the payers better understand this growing trend.
Encouraging the use of generics is only one of the ways to manage the rising costs of medications, according to Karen Ignagni, president and CEO of EmblemHealth. Data and system transparency will also help both the patients and the payers better understand this growing trend.
Transcript (slightly modified)
How has EmblemHealth been helping its customers manage the rising cost of drugs?
This is a very important issue, I’m glad you’re raising it. The rising cost of drugs—probably the most challenging policy issue in the healthcare arena today. And the reason for that is that in many situations where we have very high costs being propelled by companies that are single-source companies for those drugs. So we have a monopoly and we’re negotiating against a monopoly and it’s very hard to negotiate against a monopoly.
So the question is, what do you do? We try to create formulary structures that encourage the use of generics, although we’ve seen those costs exploding recently. We’ve seen the cost of the regular drugs that most of the population is using explode, lately. But we try to create formularies that encourage the access providing individuals a pathway to address their needs, giving them choice and letting them make choices. And, having a series of structures around them that support that with information, with transparency, and making sure that in the end, they feel that they are well supported and have their medical needs met on the pharmaceutical side.
But this whole issue of what drug for what condition—how do you look at a drug to drug, a drug to a therapy to another type of procedure or a device, for example? We really have very little data that is objectively produced and in the public domain. We need access data, we need efficiency data, we need quality performance data, and we need cost data. And we can’t run from that because individuals themselves, their households, are spending a significant amount of money in this area. Employers are spending a significant amount of money, as are states and the federal government. So we need to have better data, number 1.
We need more transparency. How much is being allocated for R&D versus profits that are at the 40% and 50% level or even higher in the case of the hepatitis drugs. That’s something the American people have a right to know. And I think that that provides transparency in the public arena so that we can have the kind of informed conversation that we need to have as Americans in this arena.
So we’re hoping that we will continue to be able to partner with pharmaceutical companies on value-based strategies but at the same time, we can’t ignore the exploding costs. And the American people, obviously, are not ignoring the exploding costs.
Dr Dalia Rotstein: Physicians Must Be Aware MS Affects People of All Backgrounds
April 24th 2024Dalia Rotstein, MD, MPH, emphazises the importance of awareness that multiple sclerosis (MS) impacts patients from various backgrounds as clinicians think through ways to improve access to care and research efforts in MS.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Beyond Insulin: The Impact of Next-Generation Diabetes Technology
April 17th 2024Experts explain how new diabetes technologies like continuous glucose monitors are transforming care beyond intensive insulin therapy, offering personalized insights and improving outcomes for patients of all treatment levels.
Read More
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
Increasing Lp(a) Awareness for Better Cardiovascular Health: Dr Mary McGowan
March 24th 2024For Lp(a) Awareness Day, Mary McGowan, MD, FNLA, chief medical officer of the Family Heart Foundation, highlights how most people with elevated Lp(a) are completely unaware that they have this increased risk and calls for increased testing.
Read More