Today I read some interesting articles: one in the Wall Street Journal (New Push Ties Cost of Drugs to How Well They Work) and other one about Covered California (UncoverMichigan.com) from a frequently visited Blog.
The Wall Street Journal reported that Express Scripts Holding Co., is currently seeking deals with pharmaceutical companies that would set pricing for some cancer drugs (expensive products) based on how well they work. Meanwhile, in California, Covered California, the state’s health insurance plan exchange (with over 1.3 million people enrolled) will cap their specialty drugs at $250 per month per prescription! This means that thousands of people with chronic diseases such as diabetes, HIV and multiple sclerosis (and others) will be assisted with their medications.
I was happy to read both of these stories today. They both bring a theme I enjoy talking about into the discussion: Values Defining Value. While Express Scripts is not saying they will not cover certain medications, they are taking a stance and asking for evidence that a medication can work and that it is worth the value (e.g., progression free survival, overall survival, money spent, patient quality of life, quality time spent with family) and not just one more drug that costs tens or even hundreds of thousands of dollars to prescribe. As for Covered California, they are taking a big step in supporting people who have costly illnesses – and I can only hope that they, too, will examine the types of medications they include on their list. It is not about having access to everything, but about having access to the right things for the right patient at the right time.
We all know healthcare is individual – what may work for me will not work at all or may cause side effects in someone else. However, we live in communities and population health (and economics) should be considered when the larger decisions are being made.