Rheumatology Care: Access & Affordability

Determining a Fair Price

Ms. Emond

According to Sarah Emond, MPP, executive vice president and COO of the Institute for Clinical and Economic Review in Boston, healthcare providers and their patients don’t have to choose between affordability and access. “We have to acknowledge the reality, but there is another path. If we acknowledge that, we can talk about fair prices leading to fair access and plenty of revenue to help with the innovation we want,” she said.

Even if drugs are priced fairly, patients may not get access to newer therapies because the price is still high, said Ms. Emond.

The nonprofit Institute for Clinical and Economic Review has completed value assessments to ensure the price paid for a drug matches the benefits a patient is receiving. This involves looking at obvious health benefits, such as living longer, but also components that can be harder to measure, such as ethical priorities and benefits beyond price. “It’s important to talk about the value of those,” Ms. Emond said.

‘[Obtaining prior authorization] is a leading source of physician dissatisfaction.’  —Dr. Edgerton

Within rheumatoid arthritis, one option is the use of novel, broad access, pay-up-to formulas that would allow patients more access to drugs and cause fewer utilization management hurdles. “Using our calculation of fair price across conditions like rheumatoid arthritis, you set a maximum price and let patients have access to the care they need,” she said.

Ms. Emond is encouraged by pricing principles recently introduced by Novartis and Sanofi, including transparency and limited U.S. increases, that would push the concept of fairer drug prices to the forefront (https://tinyurl.com/uxyzkj6w and https://tinyurl.com/uzdx4m6h).

Get Involved

The Access in Rheumatology session wrapped up with ways that rheumatologists can get involved from a legislative perspective to help improve access to care and give the specialty of rheumatology a stronger voice. Marcus Snow, MD, assistant professor of internal medicine, Division of Rheumatology, University of Nebraska, Omaha; and Elizabeth (Blair) Solow, MD, assistant professor of medicine, Division of Rheumatic Diseases, UT Southwestern, Dallas, shared their suggestions. Dr. Solow is chair of the ACR’s Government Affairs Committee, and Dr. Snow is chair of the ACR’s Committee on Rheumatologic Care.

Although physicians may feel siloed when providing care, they actually are in touch with a wide range of stakeholders in the healthcare system, including pharmacy benefit managers, nursing staff and many others, Dr. Solow said. “We should be at the table helping make health policy decisions federally and at the state level that impact rheumatology providers.”

Here are ways to get involved and help continue to improve access to care: