Using clinically nuanced cost sharing to enhance consumer access to specialty medications

Am J Manag Care. 2014 Jun 1;20(6):e242-4.

Abstract

With specialty pharmaceutical prices on the rise, patients are often expected to pay anywhere from 30% to 50% of the specialty-tier drug price through co-insurance-based cost sharing. As these prices continue to climb, patients may choose lower-value medications for their medical needs or become nonadherent for cost-related reasons. Value-based insurance design implementations for specialty medications connect cost sharing and clinical value by moving high-value medications into lower-priced tiers, adjusting cost-sharing based on patient-specific variables, applying the "reward the good soldier" strategy, and encouraging patients to seek high-performing providers.

MeSH terms

  • Cost Sharing / methods*
  • Drug Costs*
  • Drug Therapy / economics*
  • Health Services Accessibility / economics
  • Health Services Accessibility / organization & administration*
  • Humans
  • Value-Based Purchasing / economics
  • Value-Based Purchasing / organization & administration