VIable

NDHI
NAT IONAL DIALOGUE FOR
Healthcare Innovation
Anthem and Eli Lilly Policy
Collaboration
Organization Overview
• Anthem, Inc. is one of the nation’s leading health
benefits companies, offering a broad range of
medical and specialty products and covering one
in nine Americans’ health benefits.
• Eli Lilly and Company (Lilly) is one of the
country’s leading innovation-driven, researchbased
pharmaceutical and biotechnology corporations.
It is devoted to seeking answers for
some of the world’s most urgent medical needs
through discovery and development of breakthrough
medicines and technologies.
Background
The Affordable Care Act introduced public policy changes
that are transforming today’s healthcare market. This
transformation includes the shift from fee-for-service
to value based payments. It also introduced new timelines
that health plans must follow to establish annual
health insurance plan rates. These policy changes
present both opportunities and challenges relative to
how innovative medicines are reimbursed and made
available to patients.
While Anthem, Inc. and Eli Lilly and Company appear
to come from opposite sides of the table, both share
common ground in promoting discovery and the
cost-effective use of innovative treatments to improve
people’s lives. These two thought-leading companies
have come together to help accelerate the transition
towards a value-based system with policy proposals
that will help drive payment innovation.
Program Details
Anthem, Inc. and Eli Lilly and Company came together
in November 2014 in a policy collaboration to help
accelerate the transition to a value-based system.
Through this collaboration, the companies identified
two policy proposals to help drive payment innovation.
These proposals include:
1. Facilitating Open Communication about Emerging
Therapies: Create a legislative or regulatory exemption
that would allow manufacturers and health plans
to communicate about emerging products prior to
U.S. Food & Drug Administration (FDA) approval.
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Objective: Clarify federal law to confirm that
manufacturers may speak openly with health
plans about drugs going through the FDA
approval process, particularly with regard to
product efficacy, safety, and pharmacoeconomic
information.
2. Promoting Value-Based Contracting Arrangements:
Establish safe harbors in the Anti-Kickback
Statute that would allow for manufacturers and
plans to increase experimentation with value based
arrangements.
An Initiative of the
95 | Anthem and Eli Lilly Policy Collaboration