Multiple areas have been identified where oncology value frameworks can be revised in order to increase their utility to payers, according to a study in the Journal of Managed Care & Specialty Pharmacy (June 2017;23[6-a suppl):s21-s27).
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Various tools have been created by organizations such as the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), Institute for Clinical and Economic Review (ICER), and Memorial Sloan Kettering to help stakeholders assess the value of oncology treatments. These tools do not cater specifically to payers, and it is unclear the extent to which payers are using the tools as part of their drug management process.
“In order to assess value however, payers need independent analyses and guidance from expert bodies on how value in oncology can be approached,” said Jeremy Schafer, PharmaD, MBA, senior vice president, director of payer access solutions, Precision for Value, in an interview (August 2, 2017).
In efforts to better understand which value tools payers are using and what benefits and shortcomings the tools have from the payer perspective, Dr Schafer and colleagues at Precision for Value issued a survey to 28 health plan representatives from 27 unique organizations – 17 of whom were medical directors and 11 of whom were pharmacy directors. The survey asked respondents to share their experiences with utilizing value frameworks, and those attesting to using two or more value tools in drug management were eligible for an additional interview so that researchers could further understand the perceived benefits and shortcomings of current value tools.
The survey found that 71% of respondents used at least one oncology value framework to inform their drug management, 43% of respondents used two frameworks, and 14% of respondents used three frameworks.
A total of six respondents were selected for further interview. Interviewees praised current value tools for advancing the discussion on drug value and incorporating clinical evidence in their design. However, they also acknowledged that value tools vary on providing firm recommendations and relevant price benchmarks.
To create a payer-centric value framework, respondents recommended taking a firm position on product value, product comparisons in lieu of comparative clinical trials, web-based tool access, patient-reported outcomes and quality of life information, and tool updates at least quarterly to remain relevant.
“It is important for managed care executives to understand the positives and negatives of these frameworks so that coverage decisions are not made based on erroneous assumptions,” commented Dr Schafer.—Zachary Bessette
