Do Value-Based Agreements for Pharmaceuticals Provide Additional Economic Benefit to the US Health System?
Ali O1, Meads A2, Merryfield N3
1University of Portsmouth, Nottingham, NTT, UK, 2Verpora Ltd., Nottingham, NTT, UK, 3Verpora Ltd., Nottingham, UK
OBJECTIVES In recent years, payers, care purchasers and manufacturers have shown increasing interest in value-based arrangements (VBAs) for pharmaceutical products. However, critics claim VBAs do not meaningfully contribute to controlling cost or ensuring value of medicines. Through this research, we explored the impact of VBAs in the US, and whether broader implementation could bring additional economic benefit to the health system, patients, and caregivers beyond direct reductions in medicine cost. METHODS A convenience sample (n=27) of senior representatives and subject matter experts at US payer organizations engaged in VBAs were asked a series of quantitative and qualitative questions. For quantitative survey questions, descriptive statistics, including percentages for binary or categorical values and mean and median for continuous variables, were assessed. Trained reviewers collated responses to free-text survey questions to identify themes. RESULTS Participants describe tangible and intangible benefits of VBAs. In addition to benefits in ensuring drug prices align with real-world value, regional (82%) and national (91%) payers reported that VBAs contribute to improved data sharing practices and infrastructures. Additionally, 83% of payers answered that VBAs led to increased stakeholder awareness of important patient outcomes, with 66% citing that VBAs improved care coordination. In qualitative responses, payers reported that VBAs create a clear outcomes structure for the medicine, which improves the accountability of all stakeholders, particularly helping to improve measures like therapy adherence. 49% of respondents believe wider VBA implementation could lower patient out-of-pocket expense. CONCLUSIONS Findings show that most payers believe there are benefits of broader VBA in addition to realignment of drug prices. To evaluate the full potential of VBAs in the US, important legislative barriers must be addressed, and further work is required to develop an effective framework to capture the total economic benefit of VBAs to health systems with particular focus on benefits derived by patients and caregivers.
Conference/Value in Health Info
2021-05, ISPOR 2021, Montreal, Canada
Value in Health, Volume 24, Issue 5, S1 (May 2021)
Health Policy & Regulatory
Reimbursement & Access Policy, Risk-sharing Approaches