CAHC Lauds Kymriah Value-Based Arrangement: "A Win for Patients"

WASHINGTON, DC (August 30, 2017): The Council for Affordable Health Coverage (CAHC) – a coalition of employers, insurers, brokers, agents, patient groups, and physician organizations – praised the agreement announced today between Novartis and the Centers for Medicare and Medicaid Services (CMS), which is expected to allow value-based purchasing agreements for Kymriah, Novartis' newly-FDA approved immunotherapy cancer treatment. 

CAHC President Joel White released the following statement: 

"For too long, the benefit of life-saving 21st Century medical breakthroughs and cures have been stunted by payment models that hold us in the past. While we await more specific details of the agreement reached between Novartis and CMS, we believe this arrangement will be a win for patients, as it recognizes the need to reward outcomes and ensure the cost of treatment is a reflection of its clinical success. CAHC applauds CMS and Novartis on this announcement with the hope that it will be a catalyst for a broader, system-wide shift in health care towards value-based reimbursement," said CAHC President Joel White. 

White concluded, "Every consumer deserves to share in the savings that come with the shift towards value-based care. CAHC will continue working with the diverse team of stakeholders we have assembled to push for reforms to Anti-Kickback and Stark Laws as well as the Medicaid Best Price rule, all of which prevent these innovative payment models from realizing their fullest potential."
 

CAHC unveiled its Prescriptions for Affordability initiative earlier this year, offering a blueprint for lowering prescription drug costs by promoting value-based arrangements like the agreement reached between Novartis and CMS. The first-of-its-kind initiative, endorsed by stakeholders as diverse as PCMA President and CEO Mark Merritt and BIO President and CEO Jim Greenwood, noted that "Key reforms must be made to enable this shift toward value-based reimbursement. Ultimately, this kind of approach will more effectively encourage resources to be allocated to treatments that provide the most benefit at the lowest cost to consumers and society, enabling consumers and governments alike to make the most of their available resources." 

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Background:
The Council for Affordable Health Coverage (CAHC) is a broad-based alliance with a primary focus: bringing down the cost of health care for all Americans. CAHC promotes policies that lower health costs through increased competition, informed consumers and more choices to help promote access to affordable coverage. 

CAHC unveiled its Prescriptions for Affordability initiative on May 17th, as reported in PoliticoWashington Examiner, Modern Healthcare, and others. The proposal, estimated to save $71 billion a year, offers a blueprint for lowering prescription drug costs supported by drug manufacturers, insurers, pharmacy benefit managers, patient advocates, and employer groups.