High-Investment Medications: Predictability, Affordability, and Accessibility

While the Food & Drug Administration (FDA) is continuing to approve novel therapies to address important medical needs, the costs of certain therapies are raising value and affordability concerns for employers, payers, and patients. AMCP convened key stakeholders in managed care to explore solutions for improving the predictability, affordability, and accessibility of high-investment treatments, with a focus on three objectives:

1) identifying stakeholder challenges associated with high-investment medications,

2) exploring the challenges and opportunities related to financial tools to address predictability, affordability, and accessibility for high-investment medications, and

3) determining the challenges and opportunities of potential policy solutions to improve the predictability, affordability, and accessibility of high-investment treatments.

Stakeholders noted that the benefits of these therapies to patients can be significant, and though the financial costs of these high-investment drugs are substantial, these products are used in a targeted and precise manner. However, the uptake of innovative payment strategies to manage them has been slow. To prevent future challenges, payers should implement incremental changes to prepare for the future impact of the growing pipeline of high-investment medications. Opportunities for process improvement include streamlining data collection, standardizing terminology, providing education on new financial tools and policy solutions, and utilizing a variety of financial tools tailored to specific needs. Engaging and partnering multiple stakeholders will be necessary to improve the predictability of outcomes and costs, affordability for patients and the health care system, and accessibility for patients.

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