Sunday, June 14, 2015

Pay for performance

I like this idea. It would mean that if the expensive prescription medications did not work, you (and your insurance company) would get your money back. I really like this idea.

I can't tell you how many medication bottles I have in my closet for things that either didn't work or gave me an allergic reaction. But I still had to pay for them.

But in the face of these attention grabbing high prices for new medications, the insurance companies want to be able to get their money back.

"Among those leading the drive for new pricing is Express Scripts, a company that bargains with drug makers on behalf of employers and insurers. It is advancing a plan that would offer different reimbursement rates for drugs that treat more than one type of cancer based on how long the drugs extend lives. Insurers, including Harvard Pilgrim Health Care and Blue Cross Blue Shield of Massachusetts, are examining that payment arrangement and others, such as rebates to patients and insurance plans in cases where drugs aren’t effective.

The new payment criteria are likely to emerge slowly and vary widely based on types of medications and payers, which include insurance companies and some government plans such as Medicaid. But proponents agree they need to rein in prices of specialty drugs, which can run up to tens of thousands or hundreds of thousands of dollars a year."

"US health insurers, which have long talked about paying for a drug’s value, now see an opening. It remains difficult to quantify value for thousands of medications ranging from acute care drugs like antibiotics to chronic disease treatments for conditions like diabetes and high blood pressure. But advances in information technology are making it easier for doctors, hospitals, and insurers to keep track of patients and how they respond to prescribed therapies."

"“It’s a huge change for the pharma companies,” Sherman said. “They realize their prior argument — that they can’t be held responsible for the [patient] outcome — doesn’t work any more and they have to get with the program.”"

Think of it this way, you buy a pair of pants and like the way they look. But you get home and decide they don't fit right. You take them back and get a refund. Now you get a prescription and try it and you are stuck with it, even if it doesn't work. That part needs to change.

2 comments:

Becky said...

I am concerned that this type of model would be an excuse for insurance companies to not pay for life extending drugs, under the auspice that the drug didn't extend life long enough ... two months might mean a lot to some people, but nothing to the insurance companies ...

newton said...

Perhaps the new model could be explored. Newton@Kenyatta University School of Medicine