E.V.I.dently July 2019

Message from NPC

Creative Financing for Innovative Therapies

States are getting creative about how they can meet the health care needs of their citizens, especially when it comes to curative treatments for conditions with a high rate of prevalence. More recently, Louisiana became one of the first states to adopt a subscription model—what’s been termed the “Netflix” model—as a way to get more hepatitis C treatments to the people in greatest need.

The Netflix model is just one of several financing approaches that states and other organizations are testing as a way to make sure their health care dollars are being spent more efficiently and effectively, while providing patients with access to innovative, curative therapies. In his latest column for Specialty Pharmacy Times, NPC President and Chief Executive Officer Dan Leonard explores new financing models and how to overcome barriers to their implementation.

NPC Now: A Look at Our Latest Work

NPC in AJMC: Why We Need Multiple Measures of Cost-Effectiveness in the U.S.

In an editorial for The American Journal of Managed Care, NPC Chief Science Officer and Executive Vice President Robert Dubois, MD, PhD, explores the pitfalls of assigning only one organization the responsibility to assess value for the entire health care landscape. He challenges the cost-effectiveness model used in analyses by health care organizations, specifically the government-backed National Institute for Health Care Excellence in the United Kingdom and the independent Institute for Clinical and Economic Review in the United States. The incremental cost-effectiveness ratios produced by these organizations’ analyses, Dr. Dubois argues, do not fully reflect the value of new treatments and the diversity of patient characteristics and preferences. Instead, he suggests that multiple assessments performed by multiple groups have the potential to help stakeholders make better educated decisions that will ensure high-value care.

Research and Info You Need to Know

Key Takeaways From an ISPOR Panel on Creative Financing Proposals

An expert panel was convened at the International Society for Pharmacoeconomics and Outcomes Research’s (ISPOR) 2019 annual meeting to discuss the need for novel payment approaches to address the challenges that accompany transformative therapies. In a post on NPC’s blog, NPC Vice President of Research Michael Ciarametaro, MBA, and NPC/Duke-Margolis Post-doctoral Research Fellow Taruja Karmarkar, PhD, MHS, break down the key takeaways from the panel.

Webinar Archive Now Available: What’s in a Number? It Matters in Health Policy Conversations

As health care stakeholders engage in public dialogue on health care spending, there is a need for sound data to inform the discussions — however, estimates of spending on prescription medication vary widely, from a low of 10% to a high of nearly 30%. NPC and AcademyHealth hosted an interactive webinar on June 18 to understand the underlying differences in these estimates and how to address them to set the stage for a collaborative and evidence-based policy discussion. View the webinar archive now to learn more about estimates in health policy conversations.

Interested in further details about these estimates? Check out the peer-reviewed study from NPC and IQVIA published in Value in Health.

Treasury Expands Health Savings Account Benefits for Individuals Suffering from Chronic Conditions

The U.S. Department of Treasury announced in a guidance document this month that it would allow health savings account-eligible high-deductible health plans (HDHPs) the flexibility to cover essential medications and services used to treat chronic diseases prior to meeting the plan deductible. The expanded list of preventive care benefits provided by an HDHP covers medical care services and prescription drugs for certain chronic conditions. The announcement follows ongoing efforts by the University of Michigan Center for Value-based Insurance Design to call attention to the need for pre-deductible coverage; NPC provided grants for two issue briefs the Center developed on this topic. (See here and here for the briefs.)

ICYMI: Articles of Note

  • ACO Contracts With Downside Financial Risk Growing, But Still In The Minority. Kristen A. Peck, et al., July 2019, Health Affairs
  • Factors Associated with Evidence-Based Decision-Making Among Patients and Providers. Nyna Williams & Rachel Kogan, July 10, 2019, Journal of Comparative Effectiveness Research
  • Redefining the Physician's Role in Cost-Conscious Care: The Potential Role of the Electronic Health Record. Brian J. Miller, MD, MBA, MPH; Jennifer M. Slota; Jesse M. Ehrenfeld, MD, MPH. July 12, 2019, JAMA

Events and Education

Health Spending: Moving From Theory to Action

You are invited to join Health Affairs and the National Pharmaceutical Council on September 11 in Washington, DC, for an important event, “Health Spending: Moving From Theory to Action.” The event will address the pressures presented by soaring health costs on individuals, employers, and government; strategies among payers and others to promote cost effective care; and efforts currently underway to bring costs under control. Register online today!

NPC @ FT Pharma Pricing and Value Summit 2019

At the FT Pharma Pricing and Value Summit 2019, being held Sept. 26 in New York City, NPC’s Dr. Dubois will take part in a moderated panel debate with Institute for Clinical and Economic Review Executive Vice President and COO Sarah Emond on the future of value assessment frameworks in the U.S. Other topics on the Summit agenda include pricing pressures for 2020 and beyond, strategies for bringing advanced therapies to market, an update on progress of the government’s Blueprint to lower drug prices, and the use of real-world evidence in pricing models.

As a supporting sponsor of the event, employees of NPC member companies receive 10% off of registration. Use promo code FT10NP to take advantage of this offer when booking online.

“It Costs How Much? Understanding Health Care Spending and Getting to the Root of the Problem”

The NPC and National Alliance of Healthcare Purchaser Coalitions July 17 webinar, “It Costs How Much? Understanding Health Care Spending and Getting to the Root of the Problem,” examined two vexing health care spending challenges: what could we do in the U.S. to better allocate our resources and how can we ensure those resources are not wasted on low-value care. Dr. Dubois discussed activities of NPC's health care spending and value initiative and the Going Below The Surface (GBTS) Forum. Debbie Witchey, MHA, Executive Vice President and Chief Operating Officer, Healthcare Leadership Council (HLC) provided a briefing on the GBTS/HLC regional town halls and Janet McNichol, CAE, SHRM-SCP, Human Resources Director, American Speech-Language-Hearing Association, provided insights into shared benefit design processes as well findings from the NPC-funded case study, Prioritizing Health Care Spending: Engaging Employees in Health Care Benefit Design