Improving Patient Pharmaceutical Access Via Value-Based Pricing Benchmarks

July 10, 2018

We’ve spoken before on how value-based reimbursement can improve patient access to medication. A new report highlights the benefits of removing additional cost barriers by using pricing benchmarks to give patients the opportunity to have access to treatments sooner rather than later.


Medical Bag reports that the cost of specialty drugs has rapidly increased in recent years, despite few increases in commensurate efficacy.

“To manage costs, pharmacy benefit managers, employers, and insurers have created strict administrative requirements for prescribing physicians, with prior authorization and step therapy being two primary methods of cost control. These methods, however, create a substantial barrier to timely patient access,” Medical Bag shares. The findings were first reviewed in an article published in JAMA: The Journal of the American Medical Association.

The report shares that value-based price benchmarks, which take into consideration both the clinical and cost effectiveness of new medications, have been suggested to improve patient access to much-needed specialty treatments.

In the value-based model, drugs that are priced at or below the proposed benchmarks should require no prior authorization beyond physician documentation according to the label set forth by the FDA. This can help everyone involved, from the drug manufacturers to the patients, when it comes to getting the necessary drug treatments on the market. Faster to the market = faster and more affordable relief for patients waiting on prescription drugs and treatments.

The report also notes that not only will reducing prescribing barriers possibly increase the overall use of specialty medications and subsequently increase pharmaceutical revenue, but many physicians may “benefit from reduced administrative burdens and patients would benefit from access to the medications they need to sustain and improve their health,” according to the investigators.

For more on this story, visit Medical Bag.

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