Managed Care Pharmacy Issues

PDTs offer significant promise in treating certain conditions and improving access to care, but participants agreed that a new modality requires new approaches to coverage. This brief is intended to help prepare the American health care system to begin covering PDTs.

The FDA continues to approve novel therapies, but concerns arise due to the costs of certain treatments. To address this, the AMCP organized a forum to explore solutions. Stakeholders recognize the benefits of high-investment medications, but uptake of payment strategies has been slow. Gradual changes, education, and collaboration are essential to improve predictability, affordability, and accessibility for patients.

AMCP convened key stakeholders in managed care to address the balance between patient access and payer requirements in the FDA Accelerated Approval (AA) pathway program. Experts from various fields participated, aiming to identify gaps between FDAAA requirements and payer-valued treatment outcomes, explore evidence ecosystem opportunities, and evaluate policy options. The forum emphasized supporting drug development innovation while recognizing payer needs and promoting stakeholder trust in the AA review process. Notably, incentivizing confirmatory trials emerged as a potential impactful policy solution.

Discover how health technology assessment (HTA) and value assessment frameworks play a crucial role in evaluating pharmaceuticals and health interventions. The recent multistakeholder Partnership Forum, hosted by AMCP, delved into recognizing value within resource constraints. Key takeaways include emphasizing innovative pharmaceutical products, comprehensive data, and the need for trusted value assessments in healthcare decision-making. Explore best practices for enhancing value assessment tools and processes across the industry.

The Health Equity Action Brief on Geographic Inequality highlights a concerning trend of widening geographic inequality over the past four decades and what managed care can do to address these potential policy biases.

Partnership Forum: Participants discussed how digital therapeutics with web and designed based applications are emerging as a means to treat conditions by engaging people to improve health and wellness.

The AMCP Health Disparities Advisory Group conducted a landscape assessment to understand the role of managed care pharmacy in identifying and addressing health care disparities. Explore their findings and discover opportunities to dismantle inherent health disparities by downloading the assessment.

Host Fred Goldstein invites Jim Hopsicker, AMCP President & Vice President, Health and Pharmacy Management at MVP Health Care, Inc., and Susan Cantrell, AMCP CEO, to discuss the state of AMCP Priorities.

This advisory group was active from April 2021-March 2022.