title: Using clinically nuanced cost sharing to enhance consumer access to specialty medications.
abstract: With specialty pharmaceutical prices on the rise, patients are often expected to pay anywhere from 30% to 50% of the specialty-tier drug price through co-insurance-based cost sharing. As these prices continue to climb, patients may choose lower-value medications for their medical needs or become nonadherent for cost-related reasons. Value-based insurance design implementations for specialty medications connect cost sharing and clinical value by moving high-value medications into lower-priced tiers, adjusting cost-sharing based on patient-specific variables, applying the "reward the good soldier" strategy, and encouraging patients to seek high-performing providers.
authors.forename: Jason
authors.initials: J
authors.lastname: Buxbaum
authors.forename: Jonas
authors.initials: J
authors.lastname: de Souza
authors.affiliation: University of Michigan Medical Center-Division of General Medicine, 300 N Ingalls Bldg, Rm 7E06, Ann Arbor, MI 48109. E-mail: amfen@umich.edu.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
mesh_terms: D017047:Cost Sharing / Q000379:methods*; D016527:Drug Costs; D004358:Drug Therapy / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D062505:Value-Based Purchasing / Q000191:economics / Q000458:organization & administration