Scientists are rapidly developing innovative therapies for patients who once faced incurable or chronic diseases, yet the impact is only as vast as the patients’ ability to access the treatment. Affordability and social determinants of health significantly limit who has access to these important — and possibly life-changing — treatments.
For some time, the health care industry has discussed the benefits of value-based agreements (VBAs), and it’s time to recognize these innovative payment methods are critical to advancing patient health. All of us have a responsibility to evolve today’s approach to VBAs to keep the focus on the patient.
Lilly believes making the transition from volume-based to value-based approaches is one of the most important long-term changes the health care system must undertake. In creating agreements where pharmaceutical companies are rewarded for the value their products deliver to the health care system, you incentivize innovation while giving patients access to these new and potentially life-saving medicines.
While value-based payment models for medical services have become increasingly common in recent years — with more payers adopting VBAs that incorporate prescription drugs — these agreements need to evolve to provide critical patient-focused metrics that measure factors such as reduced side effects, lessened caregiver burden, and improvements to quality of life.
A key aspect to evolving and advancing VBAs is to explore what the future of these agreements may look like, which Lilly is examining in collaboration with Prime Therapeutics. This partnership will review approaches that directly benefit the patient: integrating advanced patient-focused value metrics, reducing out-of-pocket costs, incorporating care management and support services, and facilitating more accurate prescribing through data sharing.
Lilly has signed more than 50 value-based agreements since 2014, spanning across all core areas of the business. This includes large national payers in both commercial and government insurance, in addition to hospitals and clinics.
In exploring these patient-centric elements, Lilly hopes these findings will cultivate the evolution of both the industry and its regulatory bodies toward a value-based system.
The regulatory environment plays a major role in how patients pay for their medicines, and in some cases prevents the exploration of new and better methods of payment.
Several outdated policies and regulations limit the health care community’s ability to pursue innovative VBAs that address patient preferences and values. Lilly’s partnership with Prime Therapeutics will delve into these barriers and highlight policy solutions to overcome them.
While policy-change is a necessary step in enabling a value-based system, it is critical that all of us across the health care community work toward a common goal of getting patients affordable access to innovative medicines.
Payers, manufacturers, health care professionals, and patients must be willing to share real-world data to improve patient outcomes.
Lilly is committed to a fundamental cultural evolution and building internal capabilities and new functional expertise that will lend itself to advancing such agreements. Along with Prime Therapeutics, Lilly is excited to be on the front lines of designing the next generation of VBAs, with the potential to improve the lives of patients for years to come.
Lilly looks forward to working to remove the policy barriers hindering progress toward these innovative agreements, which will allow policymakers to take important steps toward improving health for patients.