Reshaping insurance design and access policies
As policymakers, insurers, and health systems explore new approaches to health technology reimbursement, there remains a need for credible evidence to inform the design of reimbursement and access policies. PHE experts have conducted groundbreaking research on the consequences of different insurance designs, including:
- The relationship between cost-sharing for diabetes therapies and patient adherence and spending
- The societal benefits and feasibility of access policies that encourage broad treatment of patients with HCV
- Medicaid antipsychotic formulary restrictions and impacts on patient costs, health care utilization, health outcomes, and imprisonment
- The importance of patient heterogeneity in determining the effectiveness of “one-size-fits-all” access policies
PHE staff and advisers are also leading thinkers on the use of innovative pricing mechanisms and reimbursement structures to increase access to important breakthroughs (eg, cures for HCV) while reducing the financial risk borne by health systems. For example, PHE experts contribute to evolving debates around the use of outcomes-based agreements, indication-specific pricing, portfolio pricing, bundled payments, and drug licenses. PHE leverages its internal expertise and also convenes external advisory groups to identify and synthesize trends in the reimbursement landscape as well as influence the debate through publication and public outreach.
- Basu A, et al. Heterogeneity in action: the role of passive personalization in comparative effectiveness research. Health Economics. 2014.
- Blumenthal DM, et al. Outcomes-based pricing as a tool to ensure access to novel but expensive biopharmaceuticals. Ann Intern Med. 2017.
- Bognar K, et al. The role of imperfect surrogate endpoint information in drug approval and reimbursement decisions. J Health Econ. 2017.
- Goldman DP, et al. Are biopharmaceutical budget caps good public policy? Economists’ Voice. 2016.
- Goldman D, et al. Medicaid prior authorization policies and imprisonment among patients with schizophrenia. Am J Manag Care. 2014.
- Goldman D, et al. Rapid biomedical innovation calls for similar innovation in pricing and value measurement. Health Affairs. 2016.
- Gupta C, et al. Reforming Medicare’s dialysis payment policies: implications for patients with secondary hyperparathyroidism. Health Serv Res. 2014.
- Lakdawalla DN, et al. Does patient cost sharing for HCV drugs make sense? Am J Manag Care. 2016.
- MacEwan JP, et al. The relationship between adherence and total spending among Medicare beneficiaries with type 2 diabetes. Am J Manag Care. 2017.
- Sussell J, et al. Value-based payments and incentives to improve care: a case study of patients with type 2 diabetes in Medicare Advantage. Value Health. 2017.
- Van Nuys K, et al. Broad hepatitis C treatment scenarios return substantial health gains, but capacity is a concern. Health Aff (Millwood). 2015.