Recent Policy Analysis on Value-Based Payment Models for Biopharmaceuticals and Related Issues

NEHI Reports, Statements, and Webinars
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“Value-Based Contracting: Supporting New Payment Arrangements,” (one page backgrounder), December 2017
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NEHI Live! Value-Based Contracting in Oncology: A Discussion on New Payment Arrangements, Webinar, October 24, 2017
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Comments: New Directions for the CMS Center for Innovation (CMMI), November 21, 2017
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“We need to remove barriers for high-cost cancer drugs,” Susan Dentzer and Thomas Hubbard, The Hill, October 24, 2017
Other Analyses Pertaining to Value-based Payment Models
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Recommendations for state Medicaid programs, "How the Federal Government Can Help States Address Rising Prescription Drug Costs,” National Academy for State Health Policy, February 2018
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Gene Therapies: Promising, Costly, Complex," Surya Singh MD, CVS Health, January 2018
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Anti Kickback Statute, Medicaid Best Price and Manufacturer-Payer Communication Issues “Overcoming the Legal and Regulatory Hurdles to Value-Based Payment Arrangements for Medical Products,” The Duke-Margolis Center for Health Policy, December 2017
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Value-based payment model options for state Medicaid programs “State Strategies for Managing Prescription Drug Spending,” Presentations to the Medicaid and CHIP Payment and Access Commission (MacPac), December 2017
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National Academies’ recommendations on drug pricing throughout the drug supply chain; includes recommendations on value-based contracting “Making Medicines Affordable: A National Imperative,” The National Academies of Science, Engineering and Medicine, Committee on Ensuring Patient Access to Affordable Drug Therapies, November 2017
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Anti Kickback Statute, Medicaid Best Price and Manufacturer-Payer Communication Issues “AMCP Partnership Forum: Advancing Value-Based Contracting,” Academy of Managed Care Pharmacy, November 2017
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Alternative Payment Models for Curative Therapies “Advancing Gene Therapies And Curative Health Care Through Value-Based Payment Reform,” Gregory Daniel, Nick Leschly, Jeff Marrazzo, Mark McClellan. The Health Affairs Blog, October 30, 2017
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Anti Kickback Statute reform and patient medication adherence A Treatable Problem: Addressing Medication Nonadherence by Reforming Government Barriers to Care Coordination, “ Prescriptions for a Healthy America, October 2017
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Systematic Review of recent value-based (performance-based, outcomes-based) contracts “Performance-Based Risk-Sharing Arrangements for Pharmaceutical Products in the United States: A Systematic Review,” Justin S. Yu, Lauren Chin, Jennifer Oh, and Jorge Farias, Journal of Managed Care and Specialty Pharmacy, October 2017
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Overview of value assessment and value-based payment options for biopharmaceuticals “Understanding The Value Of Innovations In Medicine,” Health Affairs forum (link to video and transcript), September 13, 2017
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CMS Pricing Policy on Kymriah (first approved CAR-T cancer therapy) and Alternative Payment Models “CMS: Innovative treatments call for innovative payment models and arrangements,” Centers for Medicare and Medicaid Services, August 30, 2017
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Pricing under value frameworks and value assessment: case study of New York prescription drug pricing law “Value-based Pricing and State Reform of Prescription Drug Costs”, Thomas J. Hwang, AB, Aaron S. Kesselheim, MD, JD, MPH, Ameet Sarpatwari, JD, PhD. JAMA, August 15, 2017 (subscription required)
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Medicaid Best Price and Related Federal Health Program Price Regulation “Value-Based Pricing For Pharmaceuticals In The Trump Administration,” Rachel Sachs, Nicholas Bagley and Darius N. Lakdawalla , Health Affairs Blog, April 28, 2017
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“Innovative Contracting for Pharmaceuticals and Medicaid’s Best Price Rule,” Rachel E. Sachs, Nicholas Bagley, and Darius Lakdawalla, University of Michigan Law School, Public Law and Legal Theory Research Paper Series, Paper No. 549, April 28, 2017
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Anti Kickback Statute, Medicaid Best Price and Manufacturer-Payer Communication Issues “Promoting Value-based Contracting Arrangements,” Anthem Inc., and Eli Lilly & Company, January 29, 2016
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QuintilesIMS Institute: “Global Oncology Trends 2017,” June 2017, (registration required)
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“Private Sector Risk-Sharing Agreements in the United States: Trends, Barriers, and Prospects,”Louis P. Garrison, Jr, PhD; Josh J. Carlson, PhD; Preeti S. Bajaj, PhD; Adrian Towse, MA, MPhil; Peter J. Neumann, ScD; Sean D. Sullivan, PhD; Kimberly Westrich, MA; and Robert W. Dubois, MD, PhD; American Journal of Managed Care, published online September 15, 2015
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“State Initiatives to Control Medication Costs – Can Transparency Legislation Help?”, Ameet Sarpatwari, JD, PhD, Jerry Avorn, MD, Aaron S. Kesselheim, MD, JD, MPH, New England Journal of Medicine, June 16, 2016
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MIT NewDigs Initiative: “The heterogeneity of health care payers suggests that durable therapies need precision financing targeted to each payer segment,” FOCUS Project Research Brief, February 2016