Insurers, employers, and pharmacy benefit managers (PBMs) bemoan high prices for specialty drugs and respond by closely managing patient access to drugs through prior authorization, step therapy, and consumer cost sharing. Pharmaceutical firms are concerned when the use and sale of specific drugs fall short of projections. High prices and access barriers compound each other. Pharmaceutical firms help physicians to navigate utilization management and patients to cover their financial obligations, but then must consider the costs of these programs in subsequent prices. Payers respond to price increases by intensifying access management. Physicians and patients are caught between payers and manufacturers, facing ever-higher administrative and financial obstacles.
Robinson JC, Howell S, Pearson SD. Value-Based Pricing and Patient Access for Specialty Drugs. JAMA. 2018;319(21):2169–2170. doi:10.1001/jama.2018.5367
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