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Related Concept Videos

Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Health Information Technology and Healthcare Information System01:30

Health Information Technology and Healthcare Information System

Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Standards of Care I01:22

Standards of Care I

Federal statutes profoundly impact nursing practice, providing critical guidelines to ensure patient care is equitable, accessible, and of the highest quality. The following laws address distinct aspects of healthcare provision and patient rights:
Standards of Care II01:19

Standards of Care II

Nurses bear specific legal responsibilities under several federal statutes, including:
Detection of Gross Error: The Q Test01:00

Detection of Gross Error: The Q Test

When one or more data points appear far from the rest of the data, there is a need to determine whether they are outliers and whether they should be eliminated from the data set to ensure an accurate representation of the measured value. In many cases, outliers arise from gross errors (or human errors) and do not accurately reflect the underlying phenomenon. In some cases, however, these apparent outliers reflect true phenomenological differences. In these cases, we can use statistical methods...
Pharmaceutical Equivalents01:26

Pharmaceutical Equivalents

As defined by regulatory standards, pharmaceutical equivalents require generic drug products to have identical dosage forms and chemically identical active pharmaceutical ingredients (APIs). They must adhere to compendial or applicable standards for potency, content uniformity, disintegration times, and dissolution rates. In the case of modified-release dosage forms, variations in drug content are permissible as long as the delivered amount remains consistent with the innovator drug product.

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Related Experiment Video

Updated: Jul 20, 2026

Purification of the M. magneticum Strain AMB-1 Magnetosome Associated Protein MamAΔ41
11:07

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CVS and the $100,000 QALY.

Ed Silverman

    Managed Care (Langhorne, Pa.)
    |January 9, 2019
    PubMed
    Summary

    CVS

    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.
    Keywords:
    Cost-Benefit AnalysisQuality-Adjusted Life Years

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  • 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.