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Strategies and Barriers to Affordability Kathy Donneson, Chief, - - PowerPoint PPT Presentation
Strategies and Barriers to Affordability Kathy Donneson, Chief, - - PowerPoint PPT Presentation
Strategies and Barriers to Affordability Kathy Donneson, Chief, Health Plan Administration Division, CalPERS Value-Based Strategies for Rx Insurance Design Affordability Site of Care Barriers to Strategies Affordability Value-Based
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Value-Based Insurance Design
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Personal Physician Model
Lower Copay: $10 vs. $35
Provides a place where health problems can be treated Guides patients through the health system Facilitates
- ngoing
relationship Opportunity for disease prevention Builds bridges between patients and health care providers
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Tiers
Numerical tiers
Formulary
Open-customized- closed-excluded
Medical Rx
No common codes, wide variation in cost by site
Pipeline
New drugs to market and direct to consumer ads
Pricing
Complicated pricing models
Barriers to Rx Affordability
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Way to Make Prescription Drugs More Affordable
Educate prescribers
- n costs
Direct value-based contracting Unified purchasing Reference pricing by therapeutic class Negotiate superior specialty drug pricing
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