V-BID Center Policy Update Winter 2018
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives.
AMA Joint Report Strongly Endorses V-BID
The American Medical Association Council on Medical Service and Council on Science and Public Health recently released a joint report that strongly endorsed value-based insurance design as a potential solution to align clinical and financial incentives for high-value care. The report listed eleven key policy recommendations, including the following: Support clinically nuanced V-BID plans Support the requirement of private health plans to provide coverage for evidence-based preventive services without cost-sharing for patients Support Medicare Advantage V-BID plans Support legislative and regulatory flexibility to implement V-BID, including expanding the safe harbor of HSA-eligible high-deductible health plans to include coverage for preventive care and chronic diseases Encourage national medical specialty societies to identify high-value services and collaborate with payers to experiment with plan designs that align incentives with utilization of high-value services The AMA House of Delegates adopted all report recommendations. To read the full report and AMA News [...]
RealClear Policy Op-Ed: A Patient-Centered Approach to Medicare Drug Reform
A Patient-Centered Approach to Medicare Drug Reform Dr. A Mark Fendrick, V-BID Center Director The Trump administration has recently proposed a number of sweeping changes to the Medicare program to curb taxpayer spending on prescription drugs. These include price setting, revamping how doctors and hospitals acquire drugs, and changing how physicians are reimbursed for medicines. The changes apply to “Part B,” the component of Medicare that covers medicines administered in a health-care facility, like gene therapies and advanced treatments for cancer, arthritis, and multiple sclerosis. Today, physicians purchase these medications directly. Each of the suggested reforms are blunt instruments that focus exclusively on drug prices without fully accounting for clinical value. These changes may reduce short-term expenditures, but will likely restrict access to the lifesaving medications that many seniors rely on. These policies also miss the critical clinical point that in certain patient [...]
V-BID Center Policy Update Fall 2018
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives.
Press Release: V-BID Improves Medication Adherence Without an Increase in Total Health Care Spending
Basing patients' medication costs on the health benefits they'll get from a drug, rather than its price, means they're more likely to take it Excerpt from IHPI press release:"Taking a medicine every day in the hopes that it will prevent some long-range potential health catastrophe -- like a heart attack or kidney failure -- isn’t easy.Many people skip doses, or don’t refill their prescriptions on time, or at all. And plenty of studies have shown that the more patients have to pay for those prescriptions, the less likely they are to take them as directed.But new evidence shows the power of a method aimed at changing this behavior: insurance plans that charge patients less for the medicines that could help them most. Some plans even make some of the medicines free to the patients with certain conditions.In an article published in the July issue of Health [...]
Press Release: V-BID Highlighted at Two Congressional Hearings
Press Release: V-BID Highlighted at Two Congressional Hearings The Health Subcommittee of the Congressional Committee on Ways & Means and the Joint Economic Committee held hearings on lowering health care costs and expanding access to health care. Value-Based Insurance Design principles were highlighted at both hearings as a potential cost-saving, health-improving measure. June 6, 2018: Ways and Means Hearing on Consumer-Directed Health Plans "How do we lower costs and expand access to health care?" The Health Subcommittee of the Congressional Committee on Ways & Means held a hearing on lowering costs and expanding access to health care through Consumer-Directed Health Plans. Value-Based Insurance Design principles were highlighted as a promising reform to high-deductible health plans, particularly in chronic disease management and HSA rule flexibility. Matt Eyles, President and CEO of America’s Health Insurance Plans (AHIP), highlighted that HSAs should have more [...]
V-BID Center Policy Update 2018
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives.
Press Release: Trump Administration Drug Pricing Plan Includes V-BID
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 [...]
Press Release: Meeting the Opioid Challenge in Health Affairs
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 Benefits in Medicare Advantage
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 [...]
AJMC Podcast Focuses on Recent Cost Sharing Paper and Precision Benefit Design
On April 18, 2018, The American Journal of Managed Care's Managed Care Cast interviewed Dr. A. Mark Fendrick in a segment called Examining Consumer Cost Sharing and a Precision Benefit Design With Dr Mark Fendrick. This podcast episode discussed a recently published paper, Cost Sharing and Branded Antidepressant Initiation Among Patients Treated With Generics, that examines the effects of increased cost sharing on the decision of patients with major depressive disorder (MDD) to fill prescriptions for second-line, branded antidepressants after already having tried first-line therapies. The finding that increased cost sharing for branded, second-line therapies was associated with a significant decrease in the likelihood of filling a prescription supports a dynamic, precision benefit design model in which cost sharing is lowered for higher-tier evidence-based therapies when clinically indicated. This proposed benefit design lowers consumer cost sharing for those who diligently follow the required steps for their condition, but who [...]
V-BID Center Spring Update 2018
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives from the first quarter of 2018.
V-BID Op-Ed Featured in Morning Consult: Star Wars vs. Flintstones
On March 28, 2018, the Morning Consult featured an op-ed written by V-BID Director, Dr. A. Mark Fendrick. The article, titled “The Health Care Spending Disconnect: Star Wars vs. Flintstones,” highlights the discrepancy between groundbreaking innovations in medical treatments and America's stone age care-delivery model. The disconnect between medical advancements available to patients and their ability to pay for them is addressed by the V-BID Center's Precision Benefit Design initiative, which recognizes that individualized therapies are often needed to achieve desired health outcomes. This proposed benefit design plan lowers consumer cost-sharing for patients who required a more costly targeted or alternative therapy for their condition. For the full article and more information on precision benefit design, click the buttons below.
Michigan Radio’s Stateside Podcast Features V-BID
On March 1, 2018, Michigan Radio's Stateside podcast featured an interview with V-BID Center Director, Dr. A. Mark Fendrick. The podcast focused on the widespread popularity and bipartisan support of the V-BID concept and touched on multiple V-BID Center initiatives, including clinical nuance, Precision Benefit Design, and Low-Value Care. As Americans are being asked to pay more for their health care -- the good stuff and the bad stuff -- we decided that instead of having Americans pay less for the inexpensive things and more for the expensive things, we should design an insurance product that actually makes it easy for patients to get the services that make them healthy, and maybe a little be harder for the services that don’t... -Dr. A Mark Fendrick, V-BID Center Director A. Mark Fendrick, MD, developer of the V-BID concept and Director of the University of Michigan V-BID [...]
Press Release: President’s Cancer Panel Report Includes Recommendation for Value-Based Drug Pricing
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 [...]