Resource to Check Out: Supporting Consumer Access to Specialty Medications Through Value-based Insurance Design

A new report published by the University of Michigan Center for VBID and the National Pharmaceutical Council explores how value-based insurance design may be utilized to address specialty medication access concerns. The report outlines that high spending on specialty medications is often money well spent for many patients and clinical indications given that high cost sharing for specialty medications can be harmful to patients and employers. The report describes a number of specific value-based benefit design techniques that payers and purchasers can apply to specialty medications to encourage better access and adherence to the most clinically effective treatments. Such techniques include:

- Imposing no more than modest cost sharing on high value medications;
- Reducing cost sharing based on patient or disease specific qualifications;
- Selectively reducing cost sharing for patients who fail to respond as desired to another medication based on current access restrictions used by insurance companies; or
- Using cost sharing to encourage patient selection of high performing providers.

Click here to learn more and to access the full report.