Balancing Specialty Drug Pricing and Innovation – A Framework for Sustainable Access and Affordability in the U.S. Healthcare System
Abstract
The U.S. healthcare system is facing a serious and unsustainable dilemma between the two-fold purpose of innovation in specialty drugs as an incentive and affordable and equitable access to patients. High prices caused by expensive biologic drugs and transformative cell and gene therapy and present significant access barriers to patients threaten the financial stability of the payers. The following discussion is a summary of a detailed analysis of such sources as IQVIA, the Centers of Medicare and Medicaid Services (CMS), and the Assistant Secretary of Planning and Evaluation (ASPE) to quantify the spending trends, the budget implications, and the multi-faceted character of the correlation between the price, innovation, and accessibility to patients. Two new inter-related systems have to be used to address this systemic issue; a multi-attribute Value-Sustainability Index (VSI) to capture comprehensively the therapeutic, innovative and systemic value of a drug and a National Affordability Threshold (NAT) to provide a base to price debate on macroeconomic reality. These quantitative figures indicate that the increase in the amount of Medicare Part D gross expenditure by 566.5 percent in 2012-2021 resulted in an economic amount exceeding 50 percent of the spending on specialty drugs, with much of that highly concentrated within the top 1 percent of the drugs which have caused over 41 percent of Part D spending.2 Discussion The author concludes the manuscript by pleading to implement the VSI and NAT frameworks through a multi-stakeholder and voluntary Sustainable Access Compact. This small would assist in introducing value-consistent payment models, such as outcomes-based contracting and indication-based pricing, in order to create a predictable and long-term market that does not merely compensate the actual innovation but also brings transformative medicines to the patients that need them.
Citations
IRE Journals:
Dr. Richard Amissah "Balancing Specialty Drug Pricing and Innovation – A Framework for Sustainable Access and Affordability in the U.S. Healthcare System" Iconic Research And Engineering Journals Volume 8 Issue 2 2024 Page 1158-1169 https://doi.org/10.64388/IREV8I2-1711831-4391
IEEE:
Dr. Richard Amissah
"Balancing Specialty Drug Pricing and Innovation – A Framework for Sustainable Access and Affordability in the U.S. Healthcare System" Iconic Research And Engineering Journals, 8(2) https://doi.org/10.64388/IREV8I2-1711831-4391
About IRE Journals
IRE Journals is an open access online journals established with an aim to publish high quality of research work in various diciplines. We have more than 6 years in publications. Over 2500+ papers already published.
Important Links
For Authors
Volume 8:
Issue 1, Issue 2, Issue 3, Issue 4, Issue 5, Issue 6, Issue 7, Issue 8, Issue 9, Issue 10, Issue 11, Issue 12Volume 7:
Issue 1, Issue 2, Issue 3, Issue 4, Issue 5, Issue 6, Issue 7, Issue 8, Issue 9, Issue 10, Issue 11, Issue 12Volume 6:
Issue 1, Issue 2, Issue 3, Issue 4, Issue 5, Issue 6, Issue 7, Issue 8, Issue 9, Issue 10, Issue 11, Issue 12Volume 5:
Issue 1, Issue 2, Issue 3, Issue 4, Issue 5, Issue 6, Issue 7, Issue 8, Issue 9, Issue 10, Issue 11, Issue 12Volume 4:
Issue 1, Issue 2, Issue 3, Issue 4, Issue 5, Issue 6, Issue 7, Issue 8, Issue 9, Issue 10, Issue 11, Issue 12Volume 3:
Issue 1, Issue 2, Issue 3, Issue 4, Issue 5, Issue 6, Issue 7, Issue 8, Issue 9, Issue 10, Issue 11, Issue 12