Tying Payments & Drug Pricing to Patient Outcomes

March 2017

Rising pharmaceutical prices are weighing on the bottom lines of providers, payers and pharma companies—and patients’ wallets.

To understand drug efficacy across large patient populations and improve pricing models, some healthcare industry players are leveraging new and innovative tools and pricing techniques. The goal? To better our understanding of the value of certain high-cost drugs and set reasonable outcomes expectations for patients.

“In addition to determining the value of certain drugs based on how many lives they save, healthcare leaders will be determining value based on a more fine-tuned approach called QALY, or quality-adjusted-life-years.” BDO’s Bill Bithoney said in a recent HFMA CFO Forum Q&A. This addresses the cost of medications per year of life saved, as well as the quality of the lives of those treated with the medication.

Bithoney also discussed steps providers, health plans and other industry stakeholders are exploring to address the challenges patients face paying for costly, potentially life-saving prescription drugs, including new research tools and frameworks to evaluate their costs, benefits and side effects.

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