Modernizing Drug Pricing Rules Could Save $4 Billion

March 26, 2021

Why it Matters

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Millions of Americans struggle to afford their prescriptions.

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From 2012 – 2017 prices of brand name drugs increased 10% annually.

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Drugs with varying clinical value are being introduced.

The details:

  • Value-based arrangements (VBAs) can help lower costs and improve health outcomes for patients in the commercial health insurance market by connecting payment for a drug to its value.
  • Few VBAs exist between drug manufacturers and commercial health plans because the Medicaid Best Price rule presents significant financial risk to drug manufacturers.
  • However, the Medicaid Best Price rule plays an important role in making prescription drugs affordable and accessible for Medicaid beneficiaries.
Case Study

OptumRx

OptumRx has several VBAs with drug manufacturers, including one for the immunomodulator class of drugs. Price increases for these drugs have been among the highest of all classes of specialty drugs, reaching an annual average increase of 16% in 2017.

 

VBAs Benefit Those Who:

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Experience Care

Patients may have better access to more affordable drugs that offer the best value, including innovative curative therapies.

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Provide Care

Patients’ access to costly treatments may be improved.

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Pay for Care

Payers may achieve reductions in costs for consumers, and employers will be able to better manage risk.

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Insights & Solutions

We are committed to leading in the development of the next-generation health system in a socially conscious way and driving distinguished societal return by improving health care access and affordability, enhancing the health care experience and achieving better health outcomes for the individuals and organizations we are privileged to serve.

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