Adopt value-based insurance designs


Public and private insurers should adopt value-based insurance designs to facilitate access to medically necessary and high-value therapies for patients with life-threatening and chronic conditions.

Why value-based insurance design works

Under a value-based insurance design approach, treatments that provide high clinical value have low or no patient cost-sharing to increase patient access, ensuring more affordable care for patients.

The Centers for Medicare and Medicaid Services (CMS) supports value-based insurance design. CMS implemented the Medicare Advantage Value-Based Insurance Design Model, which offers supplemental benefits or reduced out-of-pocket costs for high clinical value services to patients with certain chronic conditions.