National Pharmaceutical Council President Dan Leonard in Specialty Pharmacy Times: How Do We Pay for Medical Innovation?

Dan Leonard

We’re in the midst of a golden age of medical advancements, but in many ways, left in the Stone Age when it comes to our health care delivery system and the financing of groundbreaking therapies. As a result, we’re seeing mounting tension between these areas. Breakthrough treatments for debilitating diseases like Hepatitis C mean previously uncurable conditions can be treated in most patients, but because these are one-time, short-term treatments with a higher price, many insurers restrict the use of these medicines to all but the sickest patients.
That’s a disaster for patients, and for the health system writ large, since studies show these treatments pay for themselves over 15 years as patients avoid expensive adverse events such as liver cancer and organ transplants. But those savings don’t usually benefit the original payer, since long before those 15 years are over, the patient has likely switched to Medicare, Medicaid or a different commercial insurer. This disconnect between short-term budgets and long-term benefits, between the impact on initial payers, downstream payers and society as a whole, will only become more pronounced as medical science continues to produce better and better therapies. Additionally, the paradigm shift from chronic therapy to acute treatment (shifting a lifetime of ongoing treatment to a single or short-term treatment) can present budget challenges for payers, creating a fundamental need to transform current payment approaches.

In this month's Specialty Pharmacy Times, NPC President Dan Leonard says it’s time to think differently about how we pay for health care and assess value and benefits. Read his column to learn more about challenges and opportunities in developing creative, flexible solutions that reframe the way we analyze costs and reimbursements based on a patient’s long-term outcomes and well-being, not just the next 12 or 18 months—and not only in cases of rare disease, but for all conditions.

>> Read the Specialty Pharmacy Times Column Now