CVS Health executives Surya Singh and Troyen Brennan in a Health Affairs blog post responded to the National Pharmaceutical Council’s Robert Dubois’ criticism of the company’s program to let some plans exclude treatments with a higher than $100,000 per quality-adjusted life-year (QALY) launch price.
Dubois recently called the PBM’s approach “too much, too soon.”
“In the spirit of transparency, it is important to note that the NPC is supported by the pharmaceutical firms doing business in the United States, and Dr. Dubois’ opinions should be understood in that light,” Singh and Brennan write.
Launch prices, decided by manufacturers, have been on the rise for years, Singh and Brennan write, and that a concept like QALYs can facilitate more informed decision-making by stakeholders.
“Until now, PBMs such as CVS Health have had no ability to impact the initial launch price of a drug, which is set solely by the manufacturer, seemingly without regard to the inherent value of the medication or what the payer or patient can afford,” they write. “Our new program to exclude medications over the QALY threshold from the benefit is another tool our clients can choose to use as one of the ways to reduce the total cost of benefits.”
To read the full blog post on Health Affairs, click here.