Aetna and Cigna inked deals previous month with drug maker Novartis that give the insurers rebates tied to how well a pricey new heart failure drug works to cut hospitalizations and deaths. If the $4,500-a-year drug meets targets, the rebate goes down. Does not work so well? The insurers get a greater payment.
In another access, pharmacy benefit firm Express Scripts this year started paying drug makers a special negotiated amount for few cancer drugs. The target is to reward the utilization of medicines that are most effective for certain cancers.
Dubbed “value-based pricing,” these are the type of private-sector efforts the Obama administration expects to borrow to rein in drug prices for Medicare.
The outcomes could lead to a profound shift in how the Centers for Medicare & Medicaid Services spends $20 billion a year for drugs under Part B, which are those, provided through doctors’ offices and hospital outpatient centers. Many cancer treatments are offered that way, as are few treatments for rheumatoid arthritis, macular degeneration and other medical conditions.
Under a proposed rule, different methods would be tried in opted geographic areas over a 5 year test period. Some of these experiments would start this year, with others added in the year 2017. The proposal faces 2 months of public comment.
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