While the rest of the health care system is moving toward paying for value, payments for drugs largely continue to be stuck in a 20th century construct that focuses on price, regardless of the health outcomes of each patient. This lack of payment innovation is particularly damaging in an era where on the horizon new treatments and cures promise great benefit for consumers, but also bring great upfront costs for individuals, employers, and governments at every level. We must find a new path forward.

Paying for value requires evaluating new treatments in the context of total health costs for the patient. For example, value could be measured according to improvement in outcomes over a previous standard of care — pharmaceutical, surgical, or otherwise. Or value could recognize that certain individuals may experience better results than others. We know from experience that value-based payments are multidimensional and evolve with experience.

While there are no silver bullets, we believe it is possible to start breaking down some of the hurdles that stand in the way of a value-oriented system. Anthem and Lilly are working together to help drive policy changes that will facilitate the transition.

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