Dan Leonard, President

Peer-reviewed research conducted by the National Pharmaceutical Council (NPC) and the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center over the past 2 years sheds some light on what’s behind discrepancies in coverage decisions from one insurer to the next.

Fortunately, there is good news for patients with chronic conditions and who are in a high-deductible health plan.

Value assessment frameworks are expected to play a more pivotal role in decisions that affect future patient choice and access.

States are getting inventive in their approaches to meeting the health care needs of their citizens, especially when it comes to curative treatments for conditions that have a high prevalence rate.

As we debate who should pay for health care and how, it is critical to make clear what we expect to get for those payments: high-quality, cost-effective care that improves patient outcomes—in other words, value.

This proposal, outlined by the Centers for Medicare & Medicaid Services (CMS) in late 2018, would undermine CMS’ stated goal of prioritizing value and improved patient outcomes over utilization and sickness.

It is critical that we continue to recognize that better health outcomes are a critically important corollary to value.

Payers and biopharmaceutical companies are increasingly interested in outcomes-based agreements in which payments for a treatment are based on how well it helps patients meet specific health outcomes.