2024 Health Meeting - Session 7H: UCB Session Series - Session 1: Treatment Cost is More than the List Price of the Drug 6.25.24 Recording

When actuaries and consultants evaluate various pharmaceuticals for inclusion in an employer’s benefits offering, it can be commonplace to look at the advertised list price, or WAC (wholesale acquisition cost), between products and use that as a primary driver in the evaluation process. The true cost of a drug and its therapeutic outcome is impacted by myriad factors. This session will utilize case studies in high-cost, chronic diseases to illustrate to participants what other factors may be critical to evaluating the true cost of a pharmaceutical intervention. One case study in the Myasthenia Gravis space where two similar products have recently been approved and launched that have similar WAC prices, demonstrates that after evaluating patient populations and the weight-based dosing required of the products, the actual cost of care is significantly different between the two products. The chosen presenter will be a Medical or Pharmacy Director from a national health plan who evaluates products for formulary inclusion as part of their daily responsibilities - an expert in their field and a great facilitator to have an active dialogue with attendees. After participating in the session, the attendees will have an augmented understanding of the numerous factors, beyond just list price, that contribute to the true cost of a pharmaceutical intervention including site of care administration, the economics of buy-and-bill, and differences between the management of medical and pharmaceutical benefit products. This augmented understanding will aid the participants in providing a more holistic assessment of the cost impact associated with utilization of specialty drug therapies. Informed decision making is a critical skill for actuaries and consultants to possess in working with their clients to establish cost-effective benefit designs.