Role Of Cost And Evidence In Value-Based Purchasing Highlighted By Zaltrap Price Adjustment

As concepts such as accountable care organizations and value-based insurance design gain traction as instruments to help contain health care costs, cost as a function of value is going to receive greater attention. The recent public discourse over the pricing of Sanofi/Regeneron Pharmaceuticals Inc.’sZaltrap (ziv-aflibercept) and Memorial Sloan Kettering Cancer Center’s decision not to offer it to its advanced colorectal cancer patients offers a preview of how value-based decisions that include cost in the overall value equation could be made.

The Zaltrap example suggests a couple of lessons relative to value-based purchasing: first, that a private payer with significant clout can cite evidence of a product’s lack of clinical superiority relative to a competitor to get a discounted price and second, that payers are forging