AHCP Live Interview: Challenges and Opportunities of High-Cost Drugs

On Monday June 15, ACHP went live, hosting a conversation on high-cost drugs – and who’s footing the bill.

With more than 130 listeners calling in, Kavita Patel, M.D., managing director of clinical transformation at the Brookings Institution Center for Health Policy, facilitated the discussion. Ceci Connolly, managing director of PwC’s Health Research Institute; Eileen Wood, vice president of clinical integration and chief pharmacy officer at Capital District Physicians’ Health Plan; and Leslie Fish, vice president of clinical programs at Fallon Health, weighed in as panelists.

All three panelists emphasized the importance of innovation in health care while being cognizant of costs. If a patient can’t pay for health care services, specifically drugs as highlighted by the panelists, what is the benefit? Essentially, each panelist asked the health system at large to rethink how we deliver and how we pay for care, and how health care can be better at both.

Important topics of discussion included: the various efficacies of new drugs being developed, such as biologics for treating Hepatitis C and high cholesterol, the rising cost of both generic and brand-name drugs and how these costs affect the health care system at-large. Across the board, two key themes emerged: transparency and value.

Transparency demystifies the process of making health care decisions for consumers and provides patients with greater choice, both in terms of available treatments and payment models. Patients need to access and understand the pricing of drugs – and by doing so assume ownership of their own care decisions. By deliberately considering what they are paying for, why they are paying for it and how much they are paying, consumers can work with health care’s myriad sectors to weigh their options and ultimately make better choices. With transparency comes exploration of alternative financing models. By providing alternative models of payment, health care can begin to better align payment and cost with care delivery.

Transparency alone is not the solution to health care’s money woes. In our discussion, value emerged as an equally pressing topic. After all, a drug’s cost does not correlate to effectiveness or value. Much of the time, cost represents what the market will bear. Expensive specialty drugs are changing what the entire market is spending: Four percent of patients use specialty drugs, but specialty drugs represent 25 percent of all health care spending. Obviously, a drug’s communal value is hard to pin down, ethically and fiscally.

By creating a system by which to measure a treatment’s value, we can begin to think about facing its costs: who is bearing these costs, and how to share and reduce costs. Patients can then compare treatments, make informed decisions and choose the payment model that best works for them and their provider.

Additional information is available in PwC’s Medical Cost Trend: Behind the Numbers 2016 report, the webinar slide presentation and the webinar recording.

Zoya Haroon