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CVS and the $100,000 QALY.

Ed Silverman

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    |January 9, 2019
    PubMed
    Summary
    This summary is machine-generated.

    CVS

    Keywords:
    Cost-Benefit AnalysisQuality-Adjusted Life Years

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    Area of Science:

    • Health Economics
    • Pharmaceutical Policy
    • Drug Pricing

    Background:

    • Pharmacy benefit managers (PBMs) play a crucial role in managing drug costs.
    • The increasing cost of new pharmaceuticals presents a significant challenge to healthcare systems.
    • Value-based pricing is a growing consideration in drug formulary decisions.

    Purpose of the Study:

    • To analyze the implications of CVS's new drug pricing policy.
    • To examine the potential impact of a $100,000 per quality-adjusted life year (QALY) threshold on drug accessibility.
    • To understand the perspectives of patient advocacy groups and the pharmaceutical industry.

    Main Methods:

    • Policy analysis of CVS's formulary exclusion criteria.
    • Economic evaluation of the $100,000/QALY threshold.
    • Review of stakeholder statements and concerns.

    Main Results:

    • CVS's PBM unit implemented a policy to exclude drugs exceeding $100,000 per QALY.
    • This policy affects formulary inclusion for clients.
    • Patient groups, supported by pharmaceutical companies, argue the policy is discriminatory.

    Conclusions:

    • The $100,000/QALY threshold represents a significant cost-effectiveness benchmark in drug evaluation.
    • The policy raises concerns about equitable access to innovative medicines.
    • Stakeholder opposition highlights the complex interplay between cost, value, and patient access in pharmaceutical markets.