National Pharmaceutical Council Executive Vice President and CSO Robert Dubois in an article published on STAT News says innovative payment solutions are necessary as revolutionary therapies offer long-term health benefits.
One of the main drivers of innovation, Dubois writes, was the idea that keeping symptoms from flaring or keeping the “underlying cause of disease in check” were the best drugmakers could do. Dubois says chronic therapy would then be required to treat chronic conditions.
But patients, he says, would lean far more in favor of a one-time panacea.
” … When a lifetime of benefit can be delivered in one fell swoop, it creates new challenges,” Dubois writes. “As a society, we are not prepared to buy a lifetime of benefit all at once. We’re much better at amortizing that benefit over the course of dozens of years and hundreds of prescriptions.”
Innovative, one-time treatments, however, lead to some challenges with payment models.
“Cure a child with blindness today, and the benefits accrue markedly over time,” Dubois writes. “However, given that the average American changes health insurers every few years, the insurance company that pays for the treatment is unlikely to cover the now healthier, less-expensive patient for an extended period of time.
“Even if the price is fair, there is a seeming inequity when the payer that foots most of the cost sees only a fraction of the associated savings,” he added.