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In this Viewpoint, Peter Bach and colleague Stacie Dusetzina question the assumption underlying a 2019 proposed federal rule change to eliminate drug manufacturer rebates to pharmacy benefit managers (PBMs) as a way to decrease prescription drug prices, and they propose more extensive restructuring, including a cap on out-of-pocket spending for Medicare Part D beneficiaries, to better control drug costs and save patients money. [ABSTRACT FROM AUTHOR]

In this Viewpoint, Peter Bach and colleagues distinguish 5 pricing reform proposals implied by the concept of value-based drug pricing and discuss the potential of each to ensure value in response to unsustainable drug price increases. [ABSTRACT FROM AUTHOR]

In this article, the author reflects upon the FDA's approval of Tisagenlecleucel, a drug used to treat cancer. Topics discussed include how the drug has been approved to treat acute lymphoblastic leukemia, how a one-time infusion of the drug costs $475,000 and details relating to the drug's black box warning as its use can cause hypotension, multiorgan failure and even death. Details relating to revenue outlooks for pharmaceutical companies including Novartis and Gilead are also offered.

The authors discuss the steps that should be considered by insurers, payers and policy makers to support and achieve a value-based pricing system for drugs. Topics include Medicare, the U.S. Food and Drug Administration (FDA), and the Institute for Clinical and Economic Review (ICER) and policies preventing the ability of the Medicare to apply a value-based pricing system.

The author discussed the pricing for cancer drugs. Topics discussed include the spending on specialty drugs in 2013, Medicare price for eight cancer drugs approved by the U.S. Food and Drug Administration (FDA) in 2013, the author's claim that the price of the drug is not linked to its benefits and the formulary determinations used by the National Institute for Health and Care Excellence (NICE) of Great Britain to consider the effectiveness and cost of drugs.

The authors reflect on the high and increasing medical costs of cancer in the U.S. They note that medical expenditures for cancer increased from about 27 million U.S. dollars in 1990 to 90 billion U.S. dollars in 2008. They explain that the increase is due to increases in both the price and the quantity of care. They explore the benefit gained by physicians in fee-for-service physician payment methods used by most private and public payers.