E.V.I.dently July 2020

Message from NPC

Accumulating Barriers to Care: Double Jeopardy for U.S. Patients 

In a column for PharmaBoardroomNPC takes a look at how a new federal rule could cause patients to incur thousands of dollars in extra-out-of-pocket costs per year. The authors, Dan Leonard, NPC President and CEO, Kimberly Westrich, Vice President of Health Services Research, and Brian Sils, Senior Research Associate, take a closer look at data showing how copay accumulator programs, coupled with step therapy and prior authorization, can make it difficult for patients to access the treatments they need. 

NPC Now: A Look at Our Latest Work

Step Therapy and Post-Pandemic Patient Access to Care 

The COVID-19 pandemic has exacerbated Americans' challenges in accessing much-needed and effective care. One such hurdle, step therapy, requires patients to try a clinically recognized, lower cost first-line therapy before receiving reimbursement for an alternative therapy prescribed by the physician and can delay access to care. Taruja Karmarkar, PhD, former NPC/Duke-Margolis post-doctoral health policy fellow, Patrick Stone, Vice President, Advocacy and Government Relations, National Psoriasis Foundation, and Jennifer Graff, PharmD, NPC Vice President of Comparative Effectiveness Research take a closer look at three ways that could lessen the barriers for patients when considering post-pandemic, patient-centered formularies and access to medicines.

Get to Know NPC/Duke-Margolis Policy Fellow Salama Freed

Salama Freed, PhD, the 2020-22 NPC/Duke-Margolis post-doctoral health policy fellow, discusses her extensive background, research interests and fellowship goals in a blog post and video on NPC’s website. Her research portfolio has highlighted two intertwined investigational tracks focused on innovations in health care access and delivery: how vulnerable populations may be affected by disruptions in these innovations, and how these innovations may help to contain costs.

Other Research and Info

NPC Comments on CMS Proposed Rule on Medicaid Best Price 

In comments submitted to the Centers for Medicare and Medicaid Services (CMS) on a proposed rule, NPC outlines how Medicaid Best Price poses a barrier to developing value-based arrangements and offers recommendations to address these challenges. Currently, Medicaid Best Price hinders innovation in payment and delivery systems, which can make it difficult for patients to access new treatments like gene and cell therapies. NPC recommends that CMS resolve ambiguities and operational challenges, identify less burdensome approaches, and protect patient access to cost-sharing assistance to promote medication adherence.

NPC Comments on CMS' Inpatient Prospective Payment Proposed Rule 

On July 10, NPC submitted comments to CMS in response to its proposed rule related to the Hospital Inpatient Prospective Payment System for the upcoming fiscal year (FY2021). NPC’s comments focused on the role biopharmaceuticals have played to improve patient outcomes, the need for new methodologies to account for current and future health care technologies and enhancements to the New Technology Add-on Payment criterion. 

ICYMI: Articles of Note

  • Concannon TW, et al. Why Clinical Trials May Not Help Patients Make Treatment Decisions: Results from Focus Group Discussions with 22 Patients, July 7, 2020, Journal of Comparative Effectiveness Research
  • Gruber J, et al. The Effect of Increased Cost-Sharing on Low-Value Service Use, July 20, 2020, Health Economics 

Events and Education

Watch NPC’s Webinar on Demand: It’s Time to Talk About COVID-19 Prices

"It's Time to Talk about COVID-19 Prices," an online discussion about the societal value and pricing of potential COVID-19 treatments and incentives for current and post-pandemic medical innovation, is now available to view on demand. The 90-minute webinar, moderated by NPC Chief Science Officer Robert Dubois, MD PhD, featured four health experts: Peter Bach, MD, MAPP, of Memorial Sloan Kettering Cancer Center, Sarah Emond, MPP, of the Institute for Clinical and Economic Review, Craig Garthwaite, PhD, MPP, of the Kellogg School of Management at Northwestern University, and Peter Neumann, ScD, of the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center.

Webinar: Roadmap for Low-Value Care

Register now for an Aug. 5 webinar hosted by AMGA (American Medical Group Association) and learn how their members are taking steps to reduce low-value care throughout their organizations. Presenters from AMGA, NPC, HealthPartners Care Group and Intermountain Medical Group will unveil a roadmap for addressing low-value care developed in partnership with Going Below The Surface, a research initiative launched by NPC examining health care spending and outcomes.