Lilly & Anthem Find Common Ground in Value-Based Pricing

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We are living in an era of life-changing medicines, as stakeholders throughout the industry explore innovative solutions to improve patient outcomes. Across the country, value-based care is replacing fee-for-service models that have long been the standard. And today, Lilly and Anthem are teaming up to bring that same emphasis on value to conversations on the price of medicine.

While pharmaceutical companies and insurance providers often find themselves on opposite sides of the table, the newly announced partnership between Lilly and Anthem underscores our mutual commitment to putting patient outcomes first. We believe this important move is a natural extension of the transition toward value over volume in health care, and has the potential to foster the discovery of new therapies that improve people’s health.

As we work toward value-based pricing, we know we must overcome barriers and introduce new approaches, such as overhauling existing laws that bar manufacturers from discussing medicines before approval. While intended as a safeguard to prevent  marketing of a medicine prior to FDA approval, this provision obstructs important channels of communication that help developers and health plans prepare for a medicine’s release. Moreover, regulations designed to prohibit improper kickbacks for health insurers often have the effect of restricting partnerships between insurers and pharmaceutical companies that could provide people with better treatment.

Addressing these challenges requires a multifaceted, innovative approach, which is exactly what Lilly and Anthem are putting forward. First, federal law must evolve to enable manufacturers to speak openly and transparently with health plans about new therapies in the approval process. Second, we must cultivate an environment that encourages health plan providers and drug developers to partner. Doing so will align coverage decisions and rate development, promoting greater access to high-value care.

There is no cure-all to eliminate the barriers to progress, but these first steps will put us on a path to broadening patients’ access to the cutting-edge medicines of today and breakthrough treatments of tomorrow. With Lilly and Anthem leading the way, that path may be shorter than you’d expect.

To learn more about this collaboration, you can read the recently published op-ed by David Ricks and Dr. Samuel Nussbaum in Health Affairs, or review our white papers detailing this new initiative.