- Health plans in the U.S. appear reluctant to adopt new assessment tools designed to better assess the value of prescription drugs, even as rising prices continue to spark debate, according to a new survey conducted by Avalere Health.
- Avalere polled 11 payers, ranging from large national health plans to smaller regional groups, and found none actively used the frameworks or planned to begin using them in the near future.
- Within the past year, healthcare organizations such as the American Society of Clinical Oncology (ASCO) and the Institute for Clinical and Economic Review (ICER) have debuted new value frameworks which aim to measure drug value by accounting for cost, efficacy, improvement in quality of life and other attributes.
Although the ongoing furor over increasing prescription drug prices tends to drown out nuance, the complexity of discerning a treatment's true cost and value presents serious challenges, both for the public and for payers.
In response to often sharp rebukes on seemingly ever-rising prices, drugmakers like to point out list prices don't account for rebates and discounts and are therefore not an accurate gauge. But pharmaceutical companies haven't exactly jumped to make those agreements public, inadvertently or purposefully keeping pricing opaque rather than transparent.
At the same time, it is difficult to fairly compare prices between drugs, given the varied benefits, safety risks and cost-effectiveness of each. And each disease presents a unique context in which to assess a drug's value.
Hoping to address this problem, last year four organizations (ASCO, ICER, Memorial Sloan Kettering and the National Comprehensive Care Network) developed new frameworks to assess a drug's value.
But none of the 11 health plans surveyed by Avalere said they actively used the new tools, considering them not yet fully developed. And most of the groups did not plan to adopt the frameworks within the next year either.
Avalere polled plans involved in commercial markets, Medicare, Medicaid and exchanges, speaking to medical and pharmacy directors at each group. All but one of the respondents served on a committee responsible for recommending drug coverage.
"While current frameworks lay the ground work for the continued push toward value, there’s still room for improvement," said Josh Seidman, senior vice president of Avalere’s Center for Payment and Delivery Innovation.
"Integrating broader perspectives of value—especially the patient’s view—may help value frameworks garner greater acceptance."
One group, ICER, has seen public pushback from pharmaceutical companies for its value framework. Over the past year, ICER has said a number of leading drugs for treatment of multiple myeloma and high cholesterol are not cost effective at their current list prices.
But makers of those drugs, including Amgen, Regeneron and Bristol-Myers Squibb, have criticized the group's methodology.
Bristol-Myers, for example, called ICER's review of its multiple myeloma drug Empliciti "questionable," citing "significant limitations" in its approach. Regeneron's CEO reportedly derided ICER's assessment of the cholesterol drug Praluent as non-scientific and lacking "intellectual honesty."
ICER has solicited suggestions on how to improve its methodology and will accept comments from stakeholders through September 12 for an updated version to be rolled out next year.