What challenges or gaps in care are you focused on?
Patient OOP is shifting away from co-pays to co-insurance and deductible spending and increasing the cost burden on patients. Scientific evidence indicates that as patient costs accelerate, adherence and health outcomes decrease, while total cost of care can go up. Underserved communities are often the most affected by deleterious consequences.
What initiatives are you currently spearheading to improve health?
My team develops health economic and outcomes evidence to help support the development and adoption of patient-centric access and innovation policies. One initiative we have is research on the impact of co-pay coupon “diversion” programs such as accumulators and maximizers on patients, and our evidence suggests that accumulators and maximizers place a disproportionate burden on historically marginalized communities. This is an example of using data and methodology in a unique way to identify previously unrecognized health equity issues that need to be addressed.
What necessary collaborations/partnerships have you established within and/or outside of your organization in developing your initiatives?
We sponsor and work with the Center for Value Based Insurance Design (VBID) at the University of Michigan. With them, we are trying to find common ground and change the cost discussion from ‘How much’ to ‘How well’ to promote value-based care and better insurance design. Aligning benefit design with clinical nuance is the sustainable solution – but we need a broader debate.
What is your measurement criteria for success/or current measurable improvements have you realized from the initiative?
We always put the patient first. So we measure success when stakeholders adopt or change policies that help the patient afford and access medically appropriate care. For example, as of November 2022, 15 states require payers and pharmacy benefit managers to count copay assistance toward patient cost-sharing limits.
What gives your hope for the future in health care?
The innovation already available and in the pipeline is amazing and holds the promise of helping so many patients now and in the future. I am hopeful that we can all come together to ensure patients get access to this innovation that will help them personally and also deliver economic and humanistic value to society.
Senior Director, Leading Market Access Scientific and External Strategy
Janssen Scientific Affairs