Webinar: Health Care Coverage Challenges

The National Pharmaceutical Council's webinar "Health Care Coverage Challenges: New Treatments With High Upfront Costs, Long-term Benefits, and Delayed Savings" highlighted its recently published paper examining the disconnect between the short-term budget impact of a treatment and its downstream effects on payers and society. 

This webinar, moderated by NPC Vice President of Research Michael Ciarametaro, featured a research presentation from Genia Long, senior advisor at the Analysis Group, Inc., followed by a reactor panel with health care stakeholders, including:

  • Jeff Myers, President & CEO, Medicaid Health Plans of America
  • Michael Sherman, MD, Chief Medical Officer & Senior Vice President, Health Services, Harvard Pilgrim Health Care
  • Tim Brent, Senior Director of Business Development, National Hemophilia Foundation

Many new treatments have significant upfront costs while delivering benefits, including reduction in health care utilization and costs, over time. For example, new therapies that cure hepatitis C require a significant upfront investment, but are curative and reduce long-term costs compared with years of living with the disease and its complications. The gaps between those upfront costs and their long-term benefits and savings create challenges for employers, insurers, governments and others financing health care and making decisions about coverage. With hepatitis C treatments, the immediate budget implications of covering the treatments led many insurers, including state Medicaid programs, to limit access.  

These challenges multiply when considered in the broader context of the health coverage market, including people changing insurers and health plans over time. Government programs are particularly affected, given the large-scale shift of people into the Medicare program upon reaching age 65 and that Medicaid eligibility may change monthly.

The increasing availability of expensive, yet transformative, therapies is likely to widen the gap between the initial payer and the payer that ultimately reaps the downstream benefits. 

Learn more about these challenges and how we can address them by reading the related research paper, "Insurance Switching and the Mismatch Between the Costs and Benefits of New Technologies".