Pricey Cures Pose Reinsurance, Cost-Sharing Challenges

Genomic, curative drugs for chronic and terminal diseases are perhaps the most exciting new treatments in medicine. But even though these highly tailored therapies come to market with the potential to save costs for the health care system, the industry is struggling to pay for them because of their high up front costs. One expert says that PBMs are well-positioned to sit at the center of new financial models that distribute the high cost and substantial savings equitably across the entire industry.

“The key drug, device and diagnostic access decision-makers have oftentimes utilized traditional health economics approaches to assessing value of health care products and services. That said, value can mean different things to different decision-makers, and that’s an important distinction to make,” said Brian Leinwand, an associate principal for health economics at Avalere Health, during a June 9 webinar on alternative financing models for emergent therapies.

© 2024 MMIT
Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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