Opinion
Video
Implications and Considerations Related to Reimbursement of mAbs
In their closing thoughts the panelists discuss reimbursement-related considerations surrounding mAbs.
Adam C. Welch, PharmD, MBA, FAPhA: When you think about that public health perspective, these monoclonal antibodies, they cost money, and the cost-effectiveness has been evaluated for this. If they’re covered under a Medicaid drug benefit, what are the implications of that from a public health perspective?
Kimberly C. Chen, DO, MSHLM: Similar to what we discussed earlier, it just creates that variability vs having national coverage, understanding, and that consistency. The biggest thing, to your point earlier, is that kids who need the vaccination are the most at risk. As we talked about earlier, infants [with] Medicaid [coverage] have 91% more likelihood for hospitalization compared with [those with] commercial [insurance]. They are going to have more difficulty getting those vaccinations, much more variability, because there [are] so many different changes and so many differences between state to state vs a VFC [Vaccines for Children] program where it’s going to be consistent and the CDC [Centers for Disease Control and Prevention] will be able to negotiate much better as well. So it’s a win-win.
Adam C. Welch, PharmD, MBA, FAPhA: Dr Boyer, as a clinician, do you think about the coverage from your patients when you’re thinking about VFC vs Medicaid? Would having that inconsistency affect the way you handle taking care of your patients?
Debra Boyer, MD, MHPE: I don’t look at it. When I’m seeing a patient in the hospital, in clinic, I don’t look at what insurance they have. I just give them care. But when I go to visit, I want to give them the same as me. Prophylactic treatment that, yes, our staff has to look at their insurance and go through that whole prior approval process. And we know which pathways, as Dr Chen was talking about, are easier to navigate and which ones are going to be more challenging. But you do it anyway. But it does sometimes feel like different care or challenges for one population more than another. So we don’t want to think about it. We try not to, but at some point, we have to.
Adam C. Welch, PharmD, MBA, FAPhA: Before we conclude, I’d like to get some final thoughts from each of you. Dr Boyer, what are your thoughts on RSV [respiratory syncytial virus] prevention in infants and children?
Debra Boyer, MD, MHPE: What I’ve learned in my career [is] that kids are going to get RSV. Most kids are going to do fine, but a portion of them are not and are going to get very sick, require hospitalization, and have significant morbidity and mortality. We have strategies that can mitigate that. And we have to think about the cost benefit and the cost of the hospitalization. There’s the cost of this work for families and all this we have to think [about] as a society and figure out what’s the right path. That’s what I hope we’re able to do.
Kimberly C. Chen, DO, MSHLM: As we have discussed, RSV can result in serious consequences to infants and individuals with serious heart, lung, neuromuscular disease, immunocompromise. But it can be prevented by these antibody injections, and you can provide high-value preventive treatment for the right population. So it’s very important for us to figure out ways to decrease [and] improve our administrative processes so that the right patient can get timely access to this vaccine or preventive treatment. It depends on what ACIP decides.
Adam C. Welch, PharmD, MBA, FAPhA: It sounds like prevention is so important in this situation because the treatment has been supportive as we discussed. So a lot [is] coming down the line, and it’s really important to stay tuned to see what happens in this, to be able to prevent this disease in children.
Transcript edited for clarity.
