Episode 9 - Benefit Design and Making Treatment Affordable

Dr Dunn introduces the discussion of benefit design, suggesting that managed care providers may be unprepared to administer specialty drugs. He explains that specialty medications’ tiered system often does not incentivize providers to use less expensive medications. He suggests that stakeholders should reassess misaligned incentives in benefit design, especially for treatment options such as biosimilars.

Dr Quinn says that sometimes providers, including those like himself, are often unaware of the alternative options to newer, costlier drugs. Generics may be one way to offer providers and patients more cost-effective options for treating prostate cancer.

“It’s going to change, I think, our treatment,” Dr Quinn says. He adds that active management tools can help providers and patients understand the value of therapy options that provide equal benefits to costlier drugs, but for less out-of-pocket costs.