Biotechnology Healthcare - June 2008 - (Page 53) shock for the most important new therapies — will be essential for them to achieve the kind of health benefits promised by the new wave of biotechnology drugs. “As agents become more expensive, the companies who look at this only as a cost equation will be more and more reticent to implement their use,” he adds. “We need to re- store health and wellness to the healthcare cost debate.” Look at just about anything people buy, says Fendrick, from the clothes they wear to the cars they drive, and you’ll see that their decision to purchase isn’t based solely on cost. Fendrick wants more benefit designers to go for a more “clinically nuanced” approach for highDerek Dudek value therapies — make it easier for workers to gain access to drugs that consistently produce health benefits and worry less about providing coverage for unproven drugs. It’s time, he says, to end the onesize-fits-all approach. “I use an example of a biologic that markedly enhances physical functioning for a debilitating disease at a high efficacy rate that also is indicated for the treatment of toenail fungus,” says Fendrick. Benefits packages should make it easier for the member to get the high-value therapy for chronic disease, he suggests, and not worry so much about covering the marginal paybacks. The Rand Corp. has been delving deep into the question of whether a person’s out-of-pocket cost will discourage use of a drug. In a study published in Health Affairs,1 Rand researchers determined that the best approach to designing a drug benefit would be to lower the cost of essential therapies, urging payers to distinguish between the crucial drugs people need for chronic conditions and the lifestyle pharmaceuticals they want. When the study looked at biologics, it was found that while high out-of-pocket cost was not a big deterrent to compliance, there was nevertheless a strong argument to be made for providing generous terms to workers. “We find use is much less price sensitive compared with traditional oral agents in the treatment of cancer, kidney disease, rheumatoid arthritis (RA), and MS,” says coauthor and health economist Geoffrey Joyce in a note to BIOTECHNOLOGY HEALTHCARE. “However, that could change over time as costly biolog1 “A lot of companies are beginning to emulate what we did” with flexible drug benefit design, says Jack Mahoney, MD, director of strategic healthcare initiatives at Pitney Bowes. “They’re just later to the game.” Goldman DP, Joyce GF, Lawless G, et al. Benefit Design and Specialty Drug Use. Health Aff. 2006;25:1319–1331. MAY/JUNE 2008 · BIOTECHNOLOGY HEALTHCARE 53
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