#TBT: V-BID: Getting More Health Out Of Every Health Care Dollar

As part of our “Throwback Thursday” blog series, we’re taking a look at a topic that’s currently in the news and tagging it with previous research, videos or commentaries in a relevant way. As the saying goes, “what’s old is new again” – and we hope you enjoy our wonky twist on #TBT.

Specialty medications have been making headlines in recent weeks (The Cost Of A Cure: Medicare's Role In Treating Hepatitis C, Health Affairs; For Sovaldi patients, costly hepatitis C cure is priceless, CNBC) because they have been sparking debate over costs and patient access to promising treatments.

Specialty medications are those that typically require special handling when delivered and administered to patients. They are frequently used in the treatment of cancer, rheumatoid arthritis (RA), and multiple sclerosis (MS), as well as a number of serious and often life-threatening conditions. One of the biggest questions about these medications is how can we ensure that patients who need these treatments have continued access to them?

During the National Institute of Medicine National Cancer Policy Forum Workshop on June 9, participants considered how best to address this important question. One possible solution, posed during the Workshop by Dr. A. Mark Fendrick, director of the Value-Based Insurance Design Center at the University of Michigan, could be to utilize value-based insurance design, which shifts the focus from “how much” we spend to “how well” we spend our health care dollars.

Dr. Fendrick also authored a new booklet with NPC on this topic, Supporting Consumer Access to Specialty Medications Through Value-Based Insurance Design. As described in the booklet and by Dr. Fendrick at the Workshop, the increased prescribing of this class of innovative medications is coupled with a recent trend by public and private payers to shift a larger portion of the medication costs to consumers. The report explains that the result of this policy is that “higher cost-sharing is associated with reductions in both essential and non-essential service use.”

V-BID is built on the principle of lowering or removing financial barriers to essential, evidence-based, high-value clinical services to align patients’ out-of-pocket costs, such as copayments, with the value of services. Driven by the concept of clinical nuance, V-BID recognizes that medical services differ in the benefit they provide, and the clinical benefit derived from a specific service depends on the characteristics of the patient receiving it.

When it comes to specialty medications, payers and purchasers operating in the current health care environment can use a variety of techniques to apply V-BID, including:

• Imposing no more than modest cost-sharing on high-value medications;
• Reducing cost-sharing based on patient- or disease-specific qualifications;
• Selectively reducing cost-sharing for patients who fail to respond as desired to another medication based on current access restrictions used by insurance companies; or
• Using cost-sharing to encourage patient selection of high-performing providers.

This isn’t the first time that the V-BID concept has entered into health care discussions. The Centers for Medicare and Medicaid Services (CMS) allows its use in Medicaid programs, and many organizations such as WellPoint, Inc., Caterpillar, Inc., and the Service Employees International Union, among others, have implemented or tested V-BID.

Dr. Fendrick and NPC reviewed these organizations in case studies as part of their 2009 booklet, The Value-Based Insurance Design Landscape Digest (and our #TBT pick this week). In the Digest, the authors outlined four basic approaches to V-BID as well as how to recognize and overcome potential barriers to implementation. 

The debate over how best to provide patients with access to life-saving specialty medications won’t be solved overnight, but V-BID offers a potential solution for consideration.