Biotechnology accounts for only one percent of insurers’ costs, but those costs are growing at a double digit rate. As science produces increasingly sophisticated and expensive medical products and procedures based on the manipulation of living organisms, payers will increasingly struggle with managing their use.
In the private sector today payers are responding to the financial pressures and complexity of providing biotech products in a variety of ways. These include requiring hospitals to seek prior approval from insurers before using biotech products, or requiring that patients use an expensive therapy only if a less expensive one fails. On the public side, Medicare is exploring requiring patients to participate in clinical trials as a condition of coverage for experimental technologies.
This timely subject was addressed at a Sept. 22 luncheon briefing sponsored by the Alliance for Health Reform and the respected journal Health Affairs. The session featured four seasoned experts: James Robinson, professor of health economics at the University of California, Berkeley; Sean Tunis, former chief medical officer, Centers for Medicare and Medicaid Services and senior fellow, Health Technology Center; Jim Greenwood, president and CEO of BIO, the biotechnology trade association; and M. Carolina Hinestrosa, executive vice-president for programs in planning for the National Breast Cancer Coalition. A copy of the latest Health Affairs issue, focusing on biotech, was available to all attending. The issue contains articles by panelists Robinson and Tunis, among others.
Full Transcript (Adobe Acrobat PDF)