In the non-oncology drug space, pharmacy benefit managers have become a lot more aggressive; however, it remains to be seen whether or not the same will eventually happen in the oncology space, said John L. Fox, MD, MHA.
He added that while the panelists had discussed accountability among providers for cost and outcomes, they hadn’t yet touched upon the issue of accountability among manufacturers of drugs, devices, or diagnostics.
“I think it’s an emerging area of interest,” he said. “We have a contract with a manufacturer that says if their drug doesn't achieve the progression free survival that they found in their clinical trial, that there will be a reimbursement to the plan.”
What Priority Health is doing in that instance differs from holding companies accountable for a patient-by-patient basis to see if the drugs are performing, pointed out Scott Gottlieb, MD. Instead, Priority is holding manufacturers accountable on a global scale to demonstrate post-market what they found in the clinical trial.
Ted Okon added that there have been talks between manufacturers and CMS to consider these agreements, and there seems to be some agreement on both sides that this may be worth pursuing. However, there are structural impediments in the Medicare system that may mean CMS cannot just issue new regulations, but new legislation may need to be drafted.
“I think the challenge in all of this though is: do we have the data to adjudicate a pay-for-outcomes contract,” said Dr Fox.
Bridging the Gaps: New Strategies for Preventing Cardiovascular Disease
July 31st 2025During the Addressing Cardiovascular Risk and Intervening Early webinar, experts discussed innovative strategies for cardiovascular disease prevention, emphasizing risk assessment, lifestyle changes, and collaborative care to improve patient outcomes.
Read More
Trump Directs Pharma Companies on Cutting Drug Prices Under Most-Favored-Nation Order
July 31st 2025President Donald Trump has sent letters to pharmaceutical companies, aiming to compel them to lower drug prices in the US to match the lowest prices offered in other developed nations, a move that could significantly reduce costs and disrupt the current system of pharmacy benefit managers.
Read More