Many drugs, like the immunologic drugs used to treat inflammatory and oncologic conditions, are FDA-authorized to treat more than one condition. Given different conditions have varying clinical outcomes and costs, it is likely the same drug provides a range of value across multiple conditions. However, such drugs have traditionally had a single list price and corresponding payer net cost. Indication-based pricing and benefit design (IBPBD) is intended to address the variable clinical and economic value for the same drug across multiple treatment indications.
As this trend continues to evolve, the determination of drug value by treatment indication will create risks and/or opportunities in pharmacy benefit design, ultimately impacting pharmacy PMPM forecasting and incurred costs. Learn from faculty as they:
Provide the business context for IBPBD.
Describe varying structural approaches.
Discuss the market conditions that can motivate or demotivate payers.
Explore operational barriers.
Recommend a role for actuaries.
To bring the discussion to life, a case study will be reviewed.
By attending the session, you will be able to:
• Describe the meaning of Indication-Based Drug Pricing and Benefit Design (IDPBD).
• Understand the risks and opportunities with IBPBD.
• Articulate the advantages and disadvantages of distinguishing the value of a drug by treatment indications.