Payers push for pay-for-performance prescription prices

Insurers are turning to familiar terminology in their latest effort to thwart rising prescription drug prices, according to The Boston Globe: Pay for performance.

With the cost of specialty drugs to treat hepatitis C and certain types of cancer drugs skyrocketing, and with 10 "breakthrough" drugs expected to cost Medicare and Medicaid nearly $50 billion over the next decade, payers are pushing to link the price of high-cost treatments to how well they improve a patient's condition, the Globe said.

In this effort, insurers have an ally in pharmacy benefit management firms such as Express Scripts, which is pushing a plan that ties reimbursement rates for cancer treatments to how long those drugs can extend lives, according to the article.

Still, there will be challenges. Biopharma firms urge payers to bear in mind that factors such as diet, exercise and age contribute to the effectiveness of a drug regimen along with medication itself.

Tony Dodek, chief medical officer for Blue Cross Blue Shield Massachusetts, told the Globe that value-based pricing for pharmaceuticals will present "operational issues," but he also said it was an "intriguing idea."

For more:
- read the Boston Globe article

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