Insurers, Drug-Benefit Managers Seek To Link Drug Prices To Effectiveness
The sky-rocketing costs for new drugs are propelling the effort. But pharmaceutical companies suggest there are better ways to set new pricing models. Also in the news, two patients are suing Anthem Blue Cross, alleging that the insurer would not pay for an expensive new Hepatitis C drug, and a rebuff by the Supreme Court is raising interest among drug makers.
The Wall Street Journal:
New Push Ties Cost Of Drugs To How Well They Work
Express Scripts Holding Co., a large manager of prescription-drug benefits for U.S. employers and insurers, is seeking deals with pharmaceutical companies that would set pricing for some cancer drugs based on how well they work. The effort is part of a growing push for so-called pay-for-performance deals amid complaints about the rising price of medications, some of which cost more than $100,000 per patient a year. Some insurers and prescription-benefit managers are pushing back by arguing that they should pay less when drugs don’t work well in certain patients. Drug companies are countering with pricing models of their own, such as offering free doses during a trial period. (Loftus, 5/26)
The Wall Street Journal's Pharmalot:
Consumers Sue Anthem For Denying Coverage For A Gilead Hepatitis C Drug
The controversy over the new crop of hepatitis C treatments has taken yet another turn as consumers are starting to file lawsuits against insurers that deny them access to the medicines. Over the past two weeks, two different women alleged that Anthem Blue Cross refused to pay for the Harvoni treatment sold by Gilead Sciences because it was not deemed “medically necessary.” The issue emerges after more than a year of debate over the cost of the medicines and complaints by public and private payers that the treatments have become budget busters. The new hepatitis C treatments, which are sold by Gilead Science and AbbVie, cure more than 90% of those infected and, in the U.S., cost from $63,000 to $94,500, depending upon the drug and regimen, before any discounts. (Silverman, 5/26)
Politico Pro:
Supreme Court Turns Down Drug-Disposal Law Challenge
Local drug disposal laws are likely to be high on the pharmaceutical industry’s radar now that the Supreme Court has declined to review an Alameda County, Calif., ordinance that puts drug manufacturers on the hook for funding a prescription drug take-back program. (Karlin, 5/26)
