Strategies and Barriers to Affordability Kathy Donneson, Chief, - PowerPoint PPT Presentation

Strategies and Barriers to Affordability Kathy Donneson, Chief, Health Plan Administration Division, CalPERS

Value-Based Strategies for Rx Insurance Design Affordability Site of Care Barriers to Strategies Affordability

Value-Based Insurance Design

Personal Physician Model Lower Copay: $10 vs. $35 Provides a place Guides patients where health through the problems health system can be treated Builds bridges Facilitates Opportunity between patients ongoing for disease and health care relationship prevention providers

Barriers to Rx Affordability Pricing Complicated pricing models Pipeline New drugs to market and direct to consumer ads Tiers Numerical tiers Medical Rx No common codes, wide Formulary variation in cost by site Open-customized- closed-excluded

Reference pricing by Negotiate superior Unified purchasing therapeutic class specialty drug pricing Way to Make Prescription Drugs More Affordable Educate prescribers Direct value-based on costs contracting

Reference Pricing Expansion Site of Care Strategies