Value Purchasing Programs Make Plodding Progress Drug Manufacturers Question Some Pay-for-Performance Methodologies

摘要

In mid-July, Michael Nardone, Director of the Disabled and Elderly Health Programs Group at the Centers for Medicare and Medicaid Services (CMS), sent letters to state Medicaid programs and drug manufacturers encouraging them to consider value-based purchasing agreements for pharmaceuticals,1 Those agreements present a significant opportunity for CMS and the states to reduce huge, escalating drug costs for some of the specialty pharmaceuticals that have recently come on the market for conditions such as hepatitis C. Value-based purchasing (VBP) contracts can include provisions that lower the cost of a medication if it doesn't provide the kinds of health benefits the manufacturer says it will based on the clinical trial results. Such agreements are called "pay for performance," and they are, so far, rare. A more typical value-based contract requires the drug company to lower the cost of the drug when the insurer agrees to put that drug on a lower formulary tier than its competitors. The insurer pays that lower price regardless of whether the drug works as promised, whether it costs $10 or $10,000 per month. Neither the federal government nor the private sector has a universally accepted definition of VBP for pharmaceuticals.