Budhdeo, Sanjay; Ruhl, Michael; Agapow, Paul M; Sharma, Nikhil; Moss, Parker; (2021) Precision reimbursement for precision medicine: the need for patient-level decisions between payers, providers and pharmaceutical companies. Future Healthcare Journal , 8 (3) e695-e698. 10.7861/fhj.2021-0066.

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Abstract

Healthcare costs have been dramatically rising in developed economies worldwide. A key driver of cost increases has been high-cost drugs. The current model of reimbursement is not configured for drugs with uncertain outcomes. Future reimbursement will require better allocation of available healthcare system funds. Technological advancements have opened the door to a new type of outcomes-based reimbursement, enabling value exchange between payers and pharmaceutical companies, which we term precision reimbursement. Precision reimbursement extends beyond value-based contracts, with decisions at individual rather than aggregate level. For precision reimbursement to be adopted, there are data, computation and infrastructure requirements. All stakeholders benefit in moving to precision reimbursement for optimal resource allocation, risk sharing and, ultimately, improved outcomes. There are implementation challenges including cost, change management, information governance and development of surrogate markers. The overarching trend in medicine is toward personalised interventions, with precision reimbursement as the logical consequence.

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