New White Paper Calls for Cooperation Among Drug Manufacturers and Health Insurers for Precision Patient Assistance Programs To Reduce Healthcare…

New White Paper Calls for Cooperation Among Drug Manufacturers and Health Insurers for Precision Patient Assistance Programs To Reduce Healthcare Costs

By a News Reporter-Staff News Editor at Insurance Weekly News -- Global Healthy Living Foundation (GHLF) announces the publication of a new white paper titled, "Precision Patient Assistance Programs to Enhance Access to Clinically Indicated Therapies: Right Drug, Right Time, Right Cost-Share." Written by the University of Michigan Center for Value-Based Insurance Design and funded by GHLF, the paper explains the push-pull between insurance companies (payers) trying to reduce medication costs by creating tiered formularies and pharmaceutical companies (manufacturers) trying to provide clinically evidenced, prescribed medications to patients at an affordable cost via patient assistance programs. Studies show that patient assistance programs result in better adherence and health outcomes, yet they also drive up healthcare costs as payers build "rebate" programs into their coverage cost-sharing calculations.

In lieu of payers and manufactures taking the unlikely action of radically altering their business practices, the white paper authors argue that in light of advances in precision, personalized medicine, patient assistance programs should be nuanced to meet the needs of individual patients based on both their clinical evidence and ability to afford prescribed treatments rather than a one-size-fits-all program.

"With the rise of patient-centered care and personalized medical technology, physicians and patients are communicating better to identify medications that match a patient's short and long-term treatment goals, but the reality is that their intentions are often thwarted by payers restricting access in order to control rising healthcare costs. Often times, specialty medicines used by chronic disease patients, are the hardest hit," said Seth Ginsberg, President and Co-Founder of Global Healthy Living Foundation. "While patient assistance programs have helped millions of patients remain stable on their medications and keep their chronic disease under control, we realize that copay cards can contribute to the rising costs of healthcare if used inappropriately. A possible solution is to tailor insurance and benefit programs based on a patient's clinical history and verifiable financial need." Jump Starting the Status Quo with Value-Based Insurance Design As explained in the white paper, while patient assistance programs help patients access prescribed medicines, payers and purchasers correctly deduce that they "undermine reasonable incentives for clinicians and patients to respect plan formularies and speed members toward deductibles and out-of-pocket maximum amounts they might not otherwise satisfy, thereby increasing expenditures." They also push patients to branded, more expensive medications when a generic might lead to a clinically equivalent outcome.

Value-based insurance design (V-BID) tries to better align "out of pocket cost-sharing with the value of the underlying service." In other words, V-BID understands that clinical value is dependent on the individual patient's treatment needs and treatment goals. There is evidence demonstrating that when benefits are targeted to clinical goals, that it is possible to reduce cost-related non-adherence across different conditions. White paper authors suggest payers and manufacturers come together in a "truce" to enhance access to clinically indicated therapies and decrease the financial and logistical burden on patients/families and their health care team.

"Collaborative approaches that base assistance on the specific clinical needs of an individual are needed to serve patients' best interests. A 'precision' patient assistance program can enhance patient-centered outcomes, reduce the harm associated with high cost-sharing, and maximize the health benefits from finite patient assistance resources," said A. Mark Fendrick, M.D., Professor, Departments of Internal Medicine & Health, Management and Policy, Director, Center for Value-Based Insurance Design, University of Michigan.

Keywords for this news article include: Chronic Disease, Disease Attributes, Pathologic Processes, Personalized Medicine, Investment and Finance, Global Healthy Living Foundation.

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