PAYERS’ FAMILIARITY AND UTILIZATION OF CURRENT VALUE ASSESSMENT FRAMEWORKS AND OPINIONS ON IDEAL VALUE FRAMEWORK CRITERIA

OBJECTIVES: Organizations, such as the Institute for clinical and economic review (ICER), the American Society of Clinical Oncology (ASCO) and the national comprehensive cancer network (NCCN), have developed value assessment frameworks to determine "value" of drug therapies. These frameworks are being incorporated into clinical guidelines and may serve as the basis for purchasing and insurance coverage decisions. The purpose of this study is to determine payer perspectives of all 5 value frameworks, compare value frameworks with payers' own value assessment methods, and reach a consensus on payer opinions of the ideal value framework. METHODS: A Delphi study with 12 managed care pharmacists was performed to determine payers' opinions of the value frameworks and the characteristics of the ideal value framework. The study included 2 electronic anonymous surveys and a teleconference to discuss the results. Results are reported descriptively. RESULTS: Participants most familiar (somewhat familiar, familiar, and very familiar) with NCCN (89%), followed by ACC/AHA (78%), ICER (67%), ASCO (44%) and MSKCC DrugAbacus (33%). ICER, NCCN and ACC/AHA are currently being used by the participants, mainly as additional sources of clinical information, and each value framework is being considered for use in the future. The main reason for not utilizing value frameworks was more information was needed. The most participants (38%) said their company's drug evaluation was similar (somewhat similar and very similar) to NCCN, followed by ICER (33%). All respondents agreed that drug evaluations will become more transparent with increased utilization of value frameworks. Most participants reported that the ideal framework should be an online tool (67%) updated each time a new drug in a class is approved (55%). CONCLUSIONS: All participants agree that value frameworks would contribute to transparency of drug evaluation but the health plans need more information about the value frameworks before they will be widely utilized.