Resources
The National Pharmaceutical Council (NPC) is a health policy research organization dedicated to the advancement of good evidence and science, and to fostering an environment in the United States that supports medical innovation.
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Showing 39 Results
Study of U.S. Commercial Health Plans Shows Widespread Variation in Coverage and Reimbursement for Specialty Medicines
Research published in Health Affairs shows that insurance coverage and reimbursement for specialty medications varies substantially, finding that only 15.9% of drug coverage policies were consistent…
Are Payers Ready to Address the Financial Challenges Associated with Gene Therapy?
NPC and the Analysis Group conducted market research to explore payer views of the potential roles that existing and new alternative payment approaches could play in managing the financial risk and…
Financial Impact of HSA-HDHP Reform to Improve Access to Chronic Disease Management Medications
According to an issue brief from VBID Health, providing pre-deductible coverage for medicines used to treat common chronic conditions could lower out-of-pocket costs and increase medication adherence…
A Comparison of Coverage Restrictions for Biopharmaceuticals and Medical Procedures
Payer evaluation and coverage of pharmaceuticals and medical procedures may differ independent of their clinical benefit. Therapy access depends on factor other than cost and clinical benefit,…
Toward Better Value
There is a disconnect between the important role employers believe their pharmacy benefit managers (PBMs) play in helping to manage prescription drug benefits and employers’ perceptions of the…
Health Plan Use of Patient Data: From the Routine to the Transformational
As the abundance and variety of patient data elements and sources continue to grow, health plans seek opportunities to deepen insights from multiple sources of patient data to shape care delivery,…
Does a One Size Fits All Cost-Sharing Approach Incentivize Appropriate Medication Use?
Patients contribute to health care costs through out-of-pocket expenses, like copays and coinsurance. These cost-sharing mechanisms are intended to help payers manage costs and…
Does a One-Size-Fits-All Cost-Sharing Approach Incentivize Appropriate Medication Use? A Roundtable on the Fairness and Ethics Associated with Variable Cost Sharing
A study convened an expert roundtable of patient, payer, and employer representatives to review four case studies to understand when it would be more (or less) acceptable to require patients…
Designing Successful Bundled Payment Initiatives
The National Pharmaceutical Council led a study that identified three principles intended to maximize the positive aspects and minimize the negative consequences of bundled payments.
Data, Data Everywhere, But Access Remains a Big Issue for Researchers
This study captures the policy inconsistencies and hurdles that can hinder use of publicly funded federal and state datasets for researchers. These limitations can make it harder to conduct high…
Why Is Broader Access to Publicly Funded Data Important?
This infographic illustrates the policy inconsistencies and hurdles that can hinder use of publicly funded federal and state datasets for researchers.
Care Pathways in U.S. Health Care Settings: Current Successes and Limitations, and Future Challenges
Care pathways, also known as clinical pathways or integrated care pathways, are typically characterized as a method for managing patient care based on clinical practice guidelines, with the main…
When Does FDAMA Section 114 Apply? Ten Case Studies
There is hesitation to disseminate comparative effectiveness research because of ambiguities in the law that was established to help biopharmaceutical companies engage health plans around real-world…
Real-World Impact of Comparative Effectiveness Research Findings on Clinical Practice
This study suggests that changes are needed to enable more consistent translation of research findings into clinical practice.
Supporting Consumer Access to Specialty Medications Through Value-Based Insurance Design
Value-based insurance design (V-BID) is a key tactic payers and purchasers can use to promote access to high-value specialty medications.
Three Perspectives on the Impact of Comparative Effectiveness Research on Decision Making
In a special supplement to the May 2012 Journal of Managed Care Pharmacy, National Pharmaceutical Council Chief Science Officer Robert W. Dubois, MD, PhD, takes a closer look at comparative…
Pharmaceutical Technology Assessment: Perspectives From Payers
The processes and evidence used in making pharmaceutical coverage decisions vary substantially among US health plan payers. These variations during the pharmaceutical technology assessment (PTA)…
Your Pharmacy Benefit: Make it Work for You!
The 16-page booklet offers advice for those with prescription drug coverage through an employer, union, or other group plans. Topics include Choose Your Plan, Use Your Plan, and More Options.