Insurers struggling with drug data

In an effort to combat high drug prices, health insurance companies are trying to pay drugmakers for how well their medicines perform . But health plans are running into a problem all too familiar in digital health: They are having trouble gathering and interpreting the right data, Pro’s Darius Tahir reports this morning.

“The typical payer has claims data…but not the clinical data underlying the service they’re being billed for. The payer knows that a patient’s cholesterol was tested…but not whether his or her cholesterol levels improved since the last reading. Without that knowledge, an insurer can’t assess whether, say, the multi-thousand dollar PCSK9 inhibitor the company paid for is actually reducing “bad” cholesterol — or improving heart health.”

Read more at Politico