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.

Precision Medicine Group is an integrated team of experts in fields from advanced lab sciences to translational informatics and regulatory affairs, payer insights to marketing communications. Together, we help our pharmaceutical and life-sciences clients conquer product development and commercialization challenges in a rapidly evolving environment.