Vice President, Product Development & Clinical Operations ActiveRADAR Oracle, Arizona
Prescription drug reference pricing is an emerging pharmacy benefit management tool that aligns plan reimbursement to clinical value. Through it, benefit plan sponsors pay a single reimbursement rate for drugs that have been shown to be viable therapeutic alternatives to one another. Each therapeutic class has a specific reference price drug that is selected after a rigorous evaluation of clinical evidence and Pharmacy & Therapeutics Committee review/approval. The use of prescription drug reference pricing is an established practice in European countries with national health insurance plans. Fragmentation of benefit plans and the complexity of drug pricing and reimbursement has limited the application of this value lever within the United States.
Studies have been published studies that have demonstrated the value of drug reference pricing as a method to manage drug spend, and some managed care organizations have taken notice. This session will focus on how prescription drug reference pricing has worked in Europe and how some organizations in the United States are using this methodology as well as their results. The session will also highlight how to operationalize prescription drug reference pricing some barriers to implementation.
Learning Objectives: :
At the completion of this activity, participants should be able to:
Summarize recent research that demonstrates the impact of drug reference pricing on prescription drug spend and utilization in the United States.
List four prescription drug reference pricing essential business processes.
Describe how drug reference pricing works in concert with other pharmacy benefit management levers.
Discuss potential barriers to implementing a prescription drug reference pricing program.