Intellectual Property, Information Technology, Biomedical Research, and Marketing of Patented Products

Goldman, Dana P.; Lakdawalla, Darius N.

doi:10.1016/b978-0-444-53592-4.00013-x

Cited by 3 publications

(2 citation statements)

References 110 publications

(101 reference statements)

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“…Medicare and the private insurers are shifting from payment methods that encourage the use of new drugs, regardless of cost, to methods that encourage attention to cost as well as outcomes. In economic language, they implicitly strive for a balance between the virtues of static efficiency and those of dynamic efficiency . The pursuit of static efficiency often involves a shift in financial responsibility from the insurer to the provider, so as to encourage the latter to use technology in the most cost‐effective manner possible.…”

Section: Resultsmentioning

confidence: 99%

Value‐Based Physician Payment in Oncology: Public and Private Insurer Initiatives

Robinson

2017

Milbank Quarterly

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Public and private insurers are implementing payment mechanisms to improve coordination and reduce the cost of drug, hospital, and ancillary services for cancer patients. Some target unnecessary hospitalization, while others create incentives for prescribing lower‐cost chemotherapies and biologics. Physician payment methods in oncology require a balance between incentives for cost control and incentives for patient access to expensive specialty drugs. None of the initiatives adopt bundled methods out of concern for shifting excessive financial risk onto physicians in the context of rapid pharmaceutical innovation. Context High‐value oncology requires physicians to monitor and coordinate all aspects of care, educate and engage their patients, and adopt cost‐effective drug treatments. However, oncology practices in the United States traditionally have been reimbursed based on the number of office visits performed and through cost‐plus margins from prescription of expensive drugs. Public and private payers now are experimenting with methods of payment that include monthly care management fees, annual bonuses, and incentives for conservative choice among alternative drug regimens. Methods This paper uses case study methods to examine oncology payment initiatives at Medicare, Anthem, Aetna, and UnitedHealthcare, the nation's largest public and private health insurance plans. Findings The 4 insurers supplement traditional fee‐for‐service payment with payment methods designed to promote coordination of care and conservative use of health care resources. Medicare, Aetna, and UnitedHealthcare reward oncology practices that reduce per‐patient spending, targeting unnecessary patient visits to emergency departments and hospitals. Anthem offers monthly payments to practices that adhere to lower‐cost drug treatment pathways; Aetna increases the percentage markup on low‐cost generic chemotherapies but not on high‐cost biologics; and UnitedHealthcare removes the linkage between physician payment and spending on office‐infused drugs. As a condition for receiving the new payments, each of the initiatives requires participating practices to report and, in some cases, improve performance on quality metrics. None of the initiatives bundles payment for oncology drugs together with payment for other oncology services, out of concern for shifting financial risk onto physicians and creating access barriers for patients. Conclusions The emerging “value‐based” methods of oncology payment supplement fee‐for‐service and cost‐based reimbursements with per‐month and per‐episode payments, but none of the payers bundle spending on cancer drugs with payments for other services. Payers recognize that bundled payment could create access barriers for patients and undermine innovation in effective but expensive new pharmaceuticals.

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Section: Resultsmentioning

confidence: 99%

Value‐Based Physician Payment in Oncology: Public and Private Insurer Initiatives

Robinson

2017

Milbank Quarterly

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“…The public funding of health research could be critical in assuring the adequacy of evidence to inform the development of guidelines. 44 In the context of pharmaceutical research and development, there is evidence that public funding increases total research activity (including both public and private research) and that the increase in public research is not offset by a decrease in private research. 45 The analysis presented here speaks not only to the value of adhering to clinical practice guidelines, but also to the importance of investing in the development of guidelines and the evidence base that supports them.…”

Section: Discussionmentioning

confidence: 99%

Early HIV Treatment Led To Life Expectancy Gains Valued At $80 Billion For People Infected In 1996–2009

et al. 2014

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In late 2009 US guidelines for HIV treatment were revised to recommend the initiation of combination antiretroviral therapy (cART) earlier in the course of the disease. We analyzed the life expectancy gains of people infected with HIV between the introduction of cART in 1996 and the 2009 guideline revisions. Compared to people who initiated cART late (defined as having a CD4 cell count of less than 350 per cubic millimeter of blood), those who initiated treatment early (with a CD4 count of 350-500) could expect to live 6.1 years longer, and the earliest initiators (with a CD4 count of more than 500) could expect an extra 9.0 years of life. The total value of life expectancy gains to the early and earliest initiators of treatment was $80 billion, with each life-year valued at $150,000. The value of the survival gains was more than double the increase in drug manufacturers' revenues from early cART initiation. Our results clarify the economic implications of adherence to treatment guidelines.

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Innovation Under Regulatory Uncertainty: Evidence from Medical Technology

Stern¹

2016

SSRN Journal

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Intellectual Property, Information Technology, Biomedical Research, and Marketing of Patented Products

Cited by 3 publications

References 110 publications

Value‐Based Physician Payment in Oncology: Public and Private Insurer Initiatives

Value‐Based Physician Payment in Oncology: Public and Private Insurer Initiatives

Early HIV Treatment Led To Life Expectancy Gains Valued At $80 Billion For People Infected In 1996–2009

Innovation Under Regulatory Uncertainty: Evidence from Medical Technology

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