New analysis reveals the hidden variability in specialty drug reimbursement
A joint research initiative by Turquoise Health and ZS.
In a joint research initiative, Turquoise Health and ZS studied the U.S. reimbursement landscape of physician-administered specialty drugs across several high-cost therapeutic areas. Their joint analysis reveals insights into data that has long been hidden behind confidential contracts between payers and providers.
What factors shape provider purchasing behaviors and payer management?
The findings uncover significant variation in reimbursement rates, varying by payer channel, provider setting and therapeutic area. Commercial payers and hospital settings consistently show higher negotiated rates. The report also sheds light on the negotiation dynamics between payers and providers—factors that shape provider purchasing behavior and payer management.
Focusing on 17 medical benefit products across four therapy areas, the study offers a detailed look at how reimbursement varies across products, providers and payers. A range of therapy areas were chosen to represent diversity across budget impact, disease severity and clinical similarity as well as payer management.
Bringing more transparency to set clear expectations for all healthcare stakeholders
Historically, manufacturers have had limited visibility into how their products (and competitors) are reimbursed. Now, with the growing availability of price transparency data, that’s changing. Manufacturers can gain insights into real-world reimbursement dynamics, enabling more strategic and personalized engagement with healthcare stakeholders.
Greater transparency can also bring us closer to a future where patients can “shop” for treatments with clearer expectations and fewer surprises. Though we are still several milestones away, price transparency equips all healthcare stakeholders with tools to be more proactive, data-driven and value-focused.
Wayne Luan is GM, life sciences and Mischka Moechtar is senior manager, life sciences at Turquoise Health.
