Interns

Trump Administration "American Patients First" Drug Pricing Blueprint Includes V-BID "Value-Based transformation of our entire healthcare system is a top HHS priority" On May 11, 2018, President Trump gave a speech introducing his administration's "American Patients First" drug pricing plan, which strongly reflected V-BID concepts.  The 44-page blueprint includes lowering out of pocket costs, implementing value-based purchasing in federal programs (including indication-based pricing and long-term financing), instructing CMS to create demonstration projects to encourage value-based care and lower drug prices, and considering adjustments to HHS regulations regarding drug copay discount cards. "FDA also announced it will facilitate opportunities for enhanced information sharing between manufacturers, doctors, patients and insurers to improve patient access to medical products, including through value-based insurance." A. Mark Fendrick, MD, developer of the V-BID concept and Director of the University of Michigan V-BID Center, is available for questions or comments. View the [...]

Meeting the Opioid Challenge: Getting Naloxone to Those Who Need it Most In April 2018, the US Surgeon General recognized the gravity of the US opioid epidemic and issued a rare public health advisory calling for increased availability of naloxone. This policy explicitly acknowledges that naloxone—a rescue medication that temporarily reverses the effects of an opioid overdose—does not cure opioid addiction. However, by preventing immediate harms such as death, naloxone use offers the survivor an opportunity to enter treatment when ready.Unfortunately, national implementation of a policy aimed to enhance access to naloxone faces many practical barriers, including identifying those most likely to benefit, deciding how and where to distribute the medication, and ensuring affordability. Naloxone prices have increased markedly over the past few years and range between $20 for a generic vial to $4,500 for an easy to use auto injector. Separate from drug acquisition costs, high consumer out-of-pocket costs [...]

New Cms Rule Provides More Flexibility for V-BID Benefitsin Medicare Advantage On April 16, 2018, CMS officially published their new rule for the Medicare program contract year 2019.  This rule includes a reinterpretation of the Medicare Advantage (MA) uniformity requirement that will allow for more flexibility in benefit design for MA enrollees with specified chronic conditions.  CMS determined: Providing access to services (or specific cost sharing) that are tied to health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly is consistent with the uniformity requirement in the Medicare Advantage (MA) regulationsBeginning in 2020, CMS will wave the uniformity requirement for MA plans that provide additional supplemental benefits to chronically ill enrollees.  This change paves the way for the further incorporation of V-BID principles into the Medicare Advantage program.  While the ongoing MA V-BID Model Test will continue, plans outside of [...]

On March 16, 2018, the President's Cancer Panel released a report to the President titled "Promoting Value, Affordability, and Innovation in Cancer Drug Treatment."  The report addresses the rising cost of cancer drugs and includes a recommendation for "value-based pricing and use of cancer drugs."  Such a recommendation aligns with the core principles of value-based insurance design and supports the V-BID Center's Precision Benefit Design initiative. PART 2: Taking Action to Promote Value, Affordability, and Innovation in Cancer Drug Treatment "V-BID may be well suited to cancer care due to the increasing role of high-cost specialty drugs and the growing capability to use biomarkers to match drugs with patients most likely to benefit.  Public and private payers should develop and test V-BID programs that promote patients’ use of high-value cancer drugs." (p.15) Specific recommendations made by the President's Cancer Panel to promote value-based pricing and [...]