Ensuring the Right Drug at the Right Price

This week, the Institute for Clinical and Economic Review (ICER) published a white paper analyzing the potential for indication-specific pricing of medications in the U.S.

As drug costs continue to rise – especially for specialty medications – tools to manage drug trend are critical for payers. Indication-specific pricing makes therapy more affordable and accessible for all patients by aligning payment for a drug with the value it delivers to a particular patient population.

With the input of independent thought leaders like ICER’s Dr. Steven Pearson, we launched the Oncology Care Value^SM program (OCV) earlier this year. While some oncology medications are indicated to treat multiple types of cancer, the cost of treatment may not align with its outcomes in each type. Additionally, some patients may not respond to therapy. The OCV Program protects payers from unnecessary spending while ensuring patients are treated with the right drug for their condition at the right price.

“As manufacturers, payers, and policy makers contemplate the potential merits of indication-specific pricing and approaches to it, it is clear that individual pilots, like that of Express Scripts, will be the most likely next steps forward,” – Indication-specific Pricing of Pharmaceuticals in The U.S. Health Care System: A Report from the 2015 ICER Membership Policy Summit

Establishing a robust indication-specific pricing system is a complex undertaking that will take time, but it has advantages for patients, payers, providers and pharmaceutical manufacturers alike, according to the ICER analysis.

“There remained much support for its general goals and interest in its possibilities” among experts convened at an ICER Policy Summit, the white paper said. “Many will be watching (the Express Scripts oncology program) as a sentinel of the prospects for further development of indication-based pricing in the U.S.”

To download the full white paper, click here.