Moving toward a system that pays for and rewards clinical value.

Combining improved patient health with lower costs provides a benefit to the patient and their families while helping to keep spending manageable for the private and public entities that pay for health care. That is the fundamental idea behind value-based payment arrangements: rewarding better health outcomes and lowering costs. Too often though, health outcomes are disconnected from the price that patients and companies like ours pay for treatments and medications.

The private sector is leading the way toward a system that pays for and rewards clinical value, but public policy can help further accelerate that evolution. We constantly analyze pharmacy data to hold drug manufacturers accountable for expected health outcomes from medications and use these insights to inform future affordability strategies and health improvements. It’s an approach that should be deployed across the health system.  

At the federal level, some rules are in place to encourage value-based arrangements, but there are significant limitations to the programs, and more can be done to break down obstacles to value-based care. In particular, drugmakers should be better encouraged to participate in value-based arrangements.   

• Policymakers should enable the adoption of policies that tie cost considerations of medications and treatments to outcomes, adjust pricing rules in public programs like Medicaid to further encourage drug manufacturers to engage in value-based purchasing agreements across the health care system, and discourage manufacturers from setting higher prices by gaming rules through programs that offer inappropriate incentives to patients.