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.

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