CER Daily Newsfeed

Health Plan Formularies Lowered Barriers to Fair Access to Some Drugs, Analysis Finds

(12/19, Ed Silverman, STAT+) reports “...Kimberly Westrich, chief strategy officer at the National Pharmaceutical Council, a research organization that is financed, in part, by pharmaceutical companies, wrote us to say that, ‘overall, the… report raises important concerns about patient access. However, it is subject to numerous methodological limitations and shouldn’t be used to draw conclusions about whether payers are providing meaningful access to patients.’” Subscription Required

ICER Finds Insurers Struggled to Provide Fair Access for Obesity Drugs

(12/19, Denise Myshko, Formulary Watch) reports “...‘For example, the report adopts a narrow scope, evaluating payer alignment with only 14 out of ICER’s 27 Fair Access Criteria. Additionally, the concordance analysis excludes policies for drugs that are non-formulary or excluded from coverage[,’ NPC’s Kimberly Westrich said.]” Full

Value Viewpoint: December 20, 2024

(12/20, Kimberly Westrich, LinkedIn) comments “Yesterday, ICER released their fourth annual Fair Access report. Our team shared an evidence-based response and spoke with STAT and Managed Healthcare Executive. The report evaluates the alignment of select prescription drug coverage policies with a small subset of ‘Fair Access’ criteria that ICER developed in 2020. Though the report has limitations, it highlights a persistent challenge in the U.S. healthcare system: patients continue to face unnecessary and harmful barriers to care due to poorly designed health benefits.” Full

Beyond National Health Expenditure Data: Three Things I Wish Were Better Measured

(12/19, Michael E. Chernew, Health Affairs Forefront) comments “...At a macro level, the United States spends more on health care than other nations (largely due to price) without substantially better health outcomes, but care is not delivered at a macro level and many factors can influence cross national health comparisons. What matters is the specifics of which prices could be reduced with little decline in access or quality and which care is not improving health (and which care is). Identifying opportunities for more efficient care delivery, and payment systems/delivery models that encourage those efficiencies to be realized, is crucial, particularly since aggregate inflation-adjusted prices have actually been falling, which may not be sustainable.” Full

Video: ASHP Midyear: Real-World Data Collection Helps to Facilitate Successful Biosimilar Adoption

(12/20, Pharmacy Times) “Amanuel Kehasse, PharmD, PhD, director of clinical programs and drug information at Clearway Health, highlights the importance of real-world data collection in understanding the long-term safety, efficacy, and patient experiences with biosimilar medications...Kehasse emphasizes that medication efficacy is heavily influenced by environmental and social factors, making real-world data essential for evaluating long-term outcomes and comparative performance between reference products and biosimilars.” View Video

The Hidden Culprit Behind High Drug Prices

(12/20, Carlos Orta, RealClearHealth) comments “...PBMs also employ tactics that can obstruct patients from getting the medicines their doctors prescribe. ‘Prior authorization’ forces doctors to get PBM approval before prescribing certain drugs, often delaying critical treatments. Even worse, ‘step therapy’ -- aptly nicknamed ‘fail first’ -- requires patients to try cheaper, often less effective medications before they can access the one their doctor originally prescribed. Imagine being forced to take a medication your doctor knows won't work, suffering side effects and wasted time -- all to pad a PBM's bottom line.” Full

A Drug Price Dynamic to Watch

(12/19, Caitlin Owens, Axios) reports “...Even the Medicare-negotiated rates that the U.S. pays for some drugs is generally much higher than what other comparable countries pay for the same products, a new KFF analysis found. Why it matters: Trump seemingly dropped his proposal to drive better bargains for what the U.S. pays for drugs when he removed his ‘most favored nation’ policy proposal from his campaign website. But that certainly doesn't mean that the concept has gone away forever...Getting other countries to pay more, even if the U.S. pays less, has an obvious appeal to pharma - and a pretty obvious appeal to Trump, who hates any suggestion that the U.S. is getting ripped off.” Full