AdvocacyValue-Driven Health Care

As the U.S. health care market evolves toward a system that better recognizes and rewards value, we need to focus on pragmatic solutions that address regulations that increase uncertainty and unpredictability for payers and manufacturers and make it more difficult to explore innovative payment arrangements. 

Current rules prohibit discussions between insurance companies and biopharmaceutical companies about medicines that are on the horizon. This doesn’t give insurers the opportunity to plan their budgets, causing uncertainty about insurance premiums and other planning tools. Similarly, once a medicine is available for patients, current rules prevent manufacturers from sharing research—including FDA-requested research—with insurers and doctors, including the results of trials, data on specific patient populations use of the medicine and more. In order for biopharmaceutical companies to become partners—rather than simply vendors—we need to be able to communicate with payers about the performance of our products. Removing these barriers will promote efficiency and affordability and ensure the right drug is getting to the right patient at the right time.

Value Frameworks

Supporting Patient-Centered Health Care

When well-structured and used appropriately, frameworks to assess the value of medical tests, treatments and health care services can be useful in the private market to support patient-centered health care. However, as the number of emerging value frameworks continues to grow, we are seeing great variability in the methods and approaches being used, as well as significant issues related to the process through which frameworks are developed. 

Successful frameworks should incorporate principles such as the following to ensure they accommodate individual patient needs and that high-quality care is not sacrificed:

  • Describe a sound process that is open and transparent, with opportunity for input and a strong role for patients and physicians;
  • Support patient-centered care by considering patient preferences and heterogeneity, appropriately communicating results and avoiding misuse;
  • Deliver reliable, relevant information by using rigorous, transparent methods that rely on the full range of evidence and prioritize longer-term and broader outcomes;
  • Value continued scientific and medical progress by accounting for personalized medicine, the step-wise nature of medical progress and the inherent value of innovation;
  • Take a system-wide perspective on value by examining the full range of tests, treatments, care management approaches and health care services.

Frameworks inconsistent with these principles will make it more difficult for patients to obtain health care and treatments that best meet their needs and discourage continued medical progress.

View PhRMA’s value framework principles here.

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