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Big Companies Testing Value-Based Rx Copays


  09:44:22 am, by MedBen5   , 219 words,  
Categories: News, Prescription, Health Plan Management

Big Companies Testing Value-Based Rx Copays

Some larger employers are experimenting with a different take on pharmaceutical benefits – one that pays for drugs based on their potential to prevent higher medical costs in the future.

An NPR story says that the approach, known as value-based insurance design, is already popular for lower-cost generic drugs that manage chronic conditions like diabetes, high cholesterol and high blood pressure. By offering reduced copays, companies hope to make these medicines even more affordable for patients, with the goal of avoiding more expensive care down the road.

But how would the concept work with pricier specialty drugs, such as those used to treat rheumatoid arthritis, multiple sclerosis and cancer? Coming up with a working model may be tricky.

One issue that would have to be addressed is whether all patients, regardless of income, should have to pay the same price for a specialty drug. Another challenge: determining a copay for a condition that is uncomfortable but not crippling, such as psoriasis, compared to a more disabling condition, like rheumatoid arthritis.

“If you’ve got psoriasis, maybe you pay a 30% coinsurance for the drug,” suggests James Robinson, an economist at the University of California, Berkeley. “But if you’ve got rheumatoid arthritis, there’s no copayment.”

But Robinson adds that there is no simple method of determining medicinal values. “This stuff is complicated.”

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