This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives from the end of 2018 through mid-February 2019.
The Drug Price Iceberg: More Than Meets the Eye When it comes to the political iceberg of drug prices, there is more than meets the eye. Policies that reduce prices but do not lower consumers’ out-of-pocket costs will not address the main challenge facing most Americans. Access to affordable prescription drugs is a topic of increasing public concern. In a recent survey, 82% of respondents identified medical costs as their biggest financial challenge. Although prescription spending growth has moderated and drug spending remains a relatively small part of total medical expenditures, a 2018 Kaiser Family Foundation poll showed that a significant majority of Americans think that Congress and the president are not doing enough about the problem. The fact that a majority of American adults use prescription medications is likely driving the issue of drug affordability as a policy priority. Nearly 3 in 5 American adults take [...]
Introducing V-BID 2.0: CMS Announces Updates to Medicare Advantage V-BID Demo January 18, 2019 - The Centers for Medicare and Medicaid Services (CMS) announced transformative updates to the Medicare Advantage Value-Based Insurance Design (MA V-BID) model. These changes aim to increase choice, lower cost, and improve the quality of care for Medicare beneficiaries. The model launched on January 1, 2017, and has since been expanded to include 25 states, 9 chronic conditions, Chronic Condition Special Needs Plans, and allows participants to propose their own systems or methods for identifying eligible enrollees. Riding on the heels of the Bipartisan Budget Act of 2018, which included a directive to expand the model to all 50 states by 2020, today's release makes sweeping changes to the CY2020 model, including: Allows plans to provide reduced cost-sharing and additional benefits to enrollees in a more targeted fashion Bolsters rewards and incentives programs that plans can offer beneficiaries to [...]
White House Report Urges Broader Coverage for Chronic Diseases in HSA-Qualified High-Deductible Health Plans On December 3rd, 2018, the White House released its 119-page report, Reforming America's Healthcare System Through Choice and Competition. In this report, HHS, in collaboration with the Department of Treasury, Labor, the FTC, and the White House, sets forth many formal recommendations aimed toward developing a better health care system. The report highlights the need for HSA reform and, more specifically, advocates for the expansion of the scope of preventive care and chronic condition services covered before the minimum deductible is met. An excerpt from pages 82 and 83 is included below: "As noted above, an additional constraint on the availability and use of HSAs is the requirement that HSA-qualified plans can only provide certain preventive care benefits before the minimum deductible is met. Reconsideration of the scope of [...]
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives.
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 [...]
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 [...]
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives.
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 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 [...]
This update features policy developments, media reports, and events supporting continued momentum for multiple V-BID Center initiatives.
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 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 [...]
