1. Health Strategies Group
Key Finding #1
11/9/2018
Health Strategies Group
Author/Artist
Pricing, Outcomes Data Most Drive Health Plan Asthma Access Decisions; Clinical Data Most Drive Group Choices
Health plans acknowledge that lower net pricing is the primary driver of access decisions for asthma drugs, and predictive analysis confirms this.
We'll say to the manufacturers, we think you're more similar than different. So from a financial perspective, now it's a horse race based on best pricing or other unique contract terms. – National Plan Pharmacy
While net pricing is an important concern, plans also consider longer-term financial measures when making access decisions, such as long-term data on ER and hospitalization reductions and impact on total cost of care.
Groups state that efficacy in exacerbation reduction and long-term outcomes data are most important; additional analysis reveals net pricing also contributes significantly to access decisions.
The purpose of asthma medicine is to reduce exacerbations. We're judged nowadays by how many of our patients end up in emergency rooms, get hospitalized, or have urgent care visits. – Medical Group Allergist