Should Payers Factor in Quality of Life When Deciding Coverage for New Drugs?

Jeffrey Dunn, PharmD, MBA, chief clinical officer, Cooperative Benefits Group, discusses the rationale driving coverage for new and existing drugs and shares how US stakeholders account for metrics like quality of life.

This podcast is a highlight from part 1 of a roundtable discussion focused on chronic lymphocytic leukemia, titled, "Second-Generation BTK Inhibitors for CLL: Clinical, Managed Care Perspectives."

The second part of the roundtable can be viewed here.

Read the transcript:

I think stakeholders in the United States don't do a very good job of factoring in quality of life. If we're talking about drugs that are $10,000 to $20,000 per month, that's very difficult. We would assume that if efficacy is better, quality of life is better. I think it'd be weird if efficacy was the same and quality of life was different. I think we used the studies as surrogate for that. It’s really hard for employers or other people who are purchasing insurance to emphasize quality of life. We probably should do a better job.

We focus on data from the randomized controlled trials, but like I said earlier, I think safety is more of a patient-provider conversation. We're not making a lot of pharma decisions around safety. The honest answer is if pricing of drugs is similar, we're not going to do anything. We're going to leave it up to the provider. But if cost is different, then we're going to start looking at things like efficacy. And then we might have a conversation about preferred drugs, but I really think the primary issues are cost and efficacy.