June 13, 2018

Paying for the Next Generation of Innovative Therapies

Prescription drug pricing has received considerable attention following widely publicized decisions of some firms to charge seemingly exorbitant prices for their products. One area of concern are drugs that have not proven to be cost-effective yet have market demand and lack competition. A second area are new medicines that are extremely expensive yet cost-effective. Examples include new treatments for Hepatitis-C, and new gene therapies. Such therapies with very high up-front costs and long-term benefits pose a challenge for payers. In addition to the initial budget impact, payers stand to lose much of the long-term benefit when patients switch health plans. This may lead to adoption of policies that limit patient access to these therapies. This Forum will examine the challenges of paying for the next generation of innovative therapies. We will begin with an assessment of the pharmaceutical pipeline and potential budget impacts of new drugs coming to market over the next five years. We will then discuss the potential for drug firms to expand the use of value-based pricing when setting launch prices. Next, we will examine the growing use of outcome-based contracts and the potential of such contracts focusing on individual patient response to high price therapies. Finally, we will discuss possible models for financing cost-effective therapies with very high upfront costs.

Speakers include:

  • Stuart Altman, PhD, Professor of National Health Policy, Brandeis University
  • Steven Miller, MD, MBA, Chief Medical Officer, Express Scripts
  • Michael Sherman, MD, Chief Medical Officer, Harvard Pilgrim Healthcare
  • Patrick Smith, PharmD, Director, Clinical Pipeline Services, CVS Health 
  • Sarah Emond, MPP, Chief Operating Officer, ICER 
  • Anna Kaltenboeck, MA, Program Director, Drug Pricing Lab at Memorial Sloan Kettering 
  • Jonathan Darrow, SJD, LLM, JD, MBA, Harvard Medical School Program on Regulation, Therapeutics and Law
  • Colleen Rye, PhD, Director, FasterCures
  • Jason Spangler, MD, Executive Director of Value, Quality, & Medical Policy, Amgen
  • Kristin Viswanathan Wolff, Director, Global Government Affairs and Public Policy, bluebird bio

Agenda

Participants

Presentations

Market & Drug Development-Trends Potentially Affecting Prices
Jonathan Darrow, SJD, LLM, JD, MBA, Faculty, Harvard Medial School Program on Regulation, Therapeutics and Law

Should Launch Prices Be Based on the Value of New Therapies?
Sarah Emond, MPP, Chief Operation Officer, ICER

Outcomes, Price, and Value
Anna Kaltenboeck, MA, Program Director, Drug Pricing Lab at Memorial Sloan Kettering

Mortgages for Medical Care? Paying for Cost-Effective Therapies with High Up-Front Costs
Steven Miller, MD, MBA, Chief Medical Officer, Express Scripts