Refining moment

As CMS contemplates an experiment with value-based payment models, private payers and PBMs are already finding that such methods can decrease their reliance on some of the blunt instruments they've used to beat down drug costs.

Experiments with new reimbursement tools were catalyzed by the launch of Gilead Sciences Inc.'s Sovaldi sofosbuvir, as commercial plans and PBMs found their traditional cost-containment tools inadequate. The drug was so much more effective and tolerable than previous treatments that a tsunami of pent-up demand had gathered behind the December 2013 launch, and formulary tiers, prior authorization, step therapy and price caps would not have been sufficient to manage utilization and costs...