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This month's newsletter includes a new white paper, video and issue brief implementing V-BID principles in specialty medications.  We hope you will share this resource with interested colleagues.



The V-BID Center and NPC have released
a new white paper addressing the ongoing effects of higher cost sharing for specialty pharmaceuticals. 

The report, issue brief and video recommend using V-BID clinical nuance to evaluate the cost of a drug in relation to its clinical value and reducing costs in three ways: by eliminating or lowering high cost-sharing for certain specialty drugs, by ensuring that reductions in cost-sharing align with patients' characteristics, and by reducing cost-sharing if patients don't respond to certain specialty medications.  Read more about how V-BID can improve access to specialty medications.   
MedPAC: V-BID concepts increase medication adherencemedpac

The June 2014 MedPAC report on Medicare includes findings that support V-BID cost-sharing principles.  The analysis indicates that for Medicare patients with congestive heart failure, greater medication adherence was associated with lower medical costs (p.144).  However, this effect also depended on the beneficiaries' previous health status and age and diminishes over time.
AHRQ: Differentials in medical spending by populationahrq

Results from AHRQ's brief on U.S. medical care spending indicate that in 2011, nearly 41.5 million people (roughly 7 percent of Americans) paid $2,000 or more out-of-pocket for medical care, while nearly 1.5 percent paid $5,000 or more, and about 0.4 percent paid $10,000 or more.  The top five percent of the population accounted for 43.2 percent of total out-of-pocket expenditures with an average annual out-of-pocket expenditure of $5,141.
AJPM: Employee knowledge of V-BID plan design variesajpm

A study about consumer comprehension of V-BID plans finds that incomplete knowledge of V-BID plan components is prevalent. Three true/false questions about value-based benefit design features pertaining to preventive care visits, chronic disease medications, and premium costs were asked and roughly half of respondents answered all three correctly.  Knowledge of the plan also contributed positively to consumer satisfaction.
Reuters: Cancer doctors urged to use clinical nuancereuters

As cancer care treatments cost the U.S. more than $127 billion each year, proponents for better-aligned payment systems recommend that doctors use clinical nuance to rate drugs for advanced cancer based on a combination of clinical benefits, side effects, and price.
Crain's: Free clinics evolve to serve those in high deductible planscrains

Many of Michigan's free clinics are adopting more flexible business models to serve additional patients, particularly, those enrolled in high-deductible health plans who may be unable to afford the high out-of-pocket costs before comprehensive coverage begins.  V-BID's white paper on HSA-eligible HDHPs explores a new framework to access preventive services prior to satisfaction of the deductible. 
IHCC: Safe harbor for smoking cessation servicesIhcc
  

In accordance with ACA requirements, health plans must cover smoking cessation services with zero cost-sharing. However, safe harbor exists for plans that screen for tobacco use and offer two cessation attempts each year.  Many employers, including the University of Michigan, are offering employees select prescription and over-the-counter tobacco-cessation medications with no copay as part of these requirements.   
Fierce: Insurers respond to increasing medical cost trendsfierce

Though medical costs projections are estimated to increase by 6.8 percent in 2015, according to the 2015 medical cost trend study conducted by PricewaterhouseCoopers Health Research Institute, insurers are implementing more value-based payment models  while employers are offering more high deductible health plans and hospitals strive to operate more efficiently to reduce the cost of care. 
CWF: U.S. health care system ranks last in qualitycwf

The United States was again ranked last in the quality of its health care system, despite spending more on care than any of the other eleven countries included in the recent Commonwealth report.  Issues such as a shortage of primary care physicians, lack of access to primary care, high infant mortality rates, and lower health life expectancy contributed to the rating.
V-BID brief: Supporting consumer access to specialty medicationsbrief

 

Implementing a V-BID prescription specialty medication plan that offers clinically nuanced cost-sharing based on patient-or disease-specific characteristics and that directs consumers toward high-value providers, payers, and purchasers can improve consumers' access to necessary and specialty medications and reduce the likelihood of missed or delayed care.  
The University of Michigan Center for Value-Based Insurance Design (V-BID) leads in research, development and advocacy for innovative health benefit designs.

For more information about V-BID, please visit our website and sign up to receive our newsletter.

 

To contact the V-BID Center, email us at vbidcenter@umich.edu or call 734-615-9635.
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