To Be Clear: There is no price at which a medicine will be considered fair by everyone. In my experience, even free medicine is challenged about its price. So instead of evaluating price, best to evaluate whether the perceived value of the medicine is aligned with its price.
Organizations today are looking at identifying a price that matches the drug’s value. Called value assessments or value frameworks – these models offer an attempt to determine the right price. They use factors such as clinical benefit and unmet medical need among others to determine if the price of the medicine is in line with the value provided.
As my focus is strategic communications, I primarily look at these value assessments in terms of the broad scope of their criteria, the people and background that drive these assessments and how/when/where they are influencing others. But with everything, it’s important to first understand the basics, so I’ll start with the key assessments – based on who they are trying to influence.
KEY VALUE ASSESSMENTS
FOCUS: payers, policymakers, physicians and patients
Drug Abacus in the Drug Pricing Lab (DPL) – Founded and driven by Peter Bach, MD at Memorial Sloan Kettering Cancer Center, the DPL focuses on the development of rational approaches to drug pricing and health insurance coverage that encourage innovation while ensuring patient access and affordability. It focuses its efforts on four major areas:
- Research on the current state of U.S. drug pricing and its effects
- Development of solutions to align drug prices with value
- Pilot programs to test solutions in real world settings
- Evidence-based and unbiased resources for policy makers
The DPL provides commentary to various outlets on oncology drug pricing and highlights its tool (the Drug Abacus) to help identify value.
Institute for Clinical and Economic Review (ICER) –ICER is one of the more prominent value assessment organizations. It conducts evidence-based reviews of drugs (and other medical interventions). These reviews often take months and incorporate feedback from a variety of stakeholders. ICER was founded by Steven D. Pearson, MD, MSc, who has an extensive advisory background in health technology.
FOCUS: physicians and patients
American College of Cardiology and American Heart Association (ACC-AHA)
A joint writing committee of both organizations and comprised of experienced clinicians and specialists in cardiology, health economics and performance measures was established to address the increasing concerns over optimizing healthcare spend. Currently, the two organizations have grading systems to evaluate data from randomized clinical trials, nonrandomized studies, expert panel consensus, and case studies. The intent is to enhance the guidelines with value assessments based on reliable data.
American Society of Clinical Oncology (ASCO)
This guideline was designed to enable a physician and patient to assess the value of a particular cancer treatment regimen given the patient’s individual preferences and circumstances. The value framework incorporates clinical benefit, toxicity, and symptom palliation into a score termed the net health benefit (NHB).
National Comprehensive Cancer Network (NCCN)
The NCCN provides a value assessment that healthcare providers can use with patients to discuss therapies. The assessment categories are called “evidence blocks,” and cover:
- Efficacy of Regimen/Agent
- Safety of Regimen/Agent
- Quality of Evidence
- Consistency of Evidence
- Affordability of Regimen/Agent
But, is anyone using them?
Maybe – they are at least much more well-known than in the past. Several surveys of US health plans have been conducted over the last two years and found that most health plans are not using them. However, one study from May 2016 said that 59% of approximately 100 US health plan respondents actually had used the ICER assessment and ¾ of them used it to make P&T recommendations.
The VA Pharmacy Benefits Management Services office has announced it will use ICER drug assessment reports in drug coverage and price negotiations with pharma. Also, a recent survey of more than 200 US based oncologists and published in the Journal of Clinical Oncology found that most oncologists were aware of the value assessments and had used them in the past. Of the four assessments that impacted oncologists, they found the NCCN Evidence Blocks was ranked highest, followed by ASCO, ICER and the Drug Abacus.
Bottom line is that more and more key audiences are aware of the value assessments and some are beginning to use them.
With value assessments comes evaluation of value assessments — organizations like BIO, PHRMA, the National Health Council and the National Pharmaceutical Council have provided positions and/or recommendations on principles used in value assessments. Some criticisms have been about better incorporation of patients’ values. This aspect is what Avalere Health and FasterCures are working on — a Patient-Perspective Value Framework (PPVF) to better incorporate the patient’s perception of value. It’s expected to be issued in 2018.
So Stay Tuned – while the use of value assessments is still up in the air, the fact that more and more key audiences are well aware of them suggest that they are going to be incorporated.