AMCP Partnership Forum: Designing Benefits and Payment Models for Innovative, High-Investment Medications
Xcenda is proud to participate in and support the 2018 AMCP Partnership Forums. On July 24 and 25, Xcenda's Ana Stojanovska, Vice President of Commercial Consulting, joined more than 30 experts from health plans, integrated delivery systems, pharmacy benefit managers, employers, national professional associations, the federal government, and biopharmaceutical companies in a forum titled, Designing Benefits and Payment Models for Innovative, High-Investment Medications.
The participants discussed different options for new payment models to address emerging high-investment medications.
“In my opinion, the greatest challenge in paying for high-investment medications is the ability to recognize the value of the therapy over the term of the policy," says Ana Stojanovska, Vice President of Commercial Consulting. "It is helpful to actually look to the past for case studies of what has worked. Not only have payers evolved their benefit designs, but the government has stepped in at times to offer new coverage options. The ESRD benefit is an example of how Medicare has remained flexible over the years to account for a variety of dynamics including high-cost advances in medical treatment. We are likely to see a combination of approaches for covering the high-investment, potentially curative therapies in the future.”
Participants also agreed that stakeholders must have access to real-world evidence to evaluate performance of new therapies over time and validate long-term safety and efficacy.
AMCP will publish a proceedings document based on the Partnership Forum discussion in the Journal of Managed Care & Specialty Pharmacy (JMCP)
. The document will include an overview of current financial payment models, specific challenges inherent in each model, a priority list of potential solutions, and a priority list of legal, regulatory and operational hurdles that must be considered in the development of solutions. To learn more about topics at the 2018 AMCP Partnership Forums, please visit: http://www.amcp.org/PartnershipTopics.aspx