JMCP Special Supplement Examines Frameworks for Assessing Value of Oncology Treatments
To address escalating drug costs, health care payers increasingly are adopting benefit designs that aim to identify and pay for medications based on their value.
Alexandria, Va., June 5, 2017 — To address escalating drug costs, health care payers increasingly are adopting benefit designs that aim to identify and pay for medications based on their value. The June issue of the Journal of Managed Care & Specialty Pharmacy (JMCP) features a special supplement comparing existing “value frameworks” used in such benefit designs to assess high-cost oncology treatments.
The five articles in the supplement, “Value-Based Framework Considerations for Managed Care Pharmacy,” raise important questions about these frameworks, including the core challenge of how to define value. JMCP is the official journal of the Academy of Managed Care Pharmacy.
The basic premise underlying value frameworks — i.e., that decisions about medical treatment can be improved by providing standardized comparisons of treatments’ benefits and costs — is generally accepted as valid. But for value frameworks to reach their full potential, some questions must be answered, such as:
- Who is the audience? While each framework may take an explicit perspective (e.g., payer or patient), they all aim to be broadly useful. One study notes the difficulties in identifying the actual “consumer” in the equation, as patients look to providers to choose treatments and to insurers to pay for them.
- One size fits all vs. custom tailoring? Payers largely prefer to be told what to cover and what not to cover, according to one study. However, a clear tension exists between this bright-line approach and the growing appreciation for patient heterogeneity, as found the trend toward “personalized medicine.”
- Do the frameworks agree? Frameworks agree at least some of the time, but not always, according to another study. This situation is not automatically a bad thing, as frameworks may focus on different attributes, such as cost effectiveness vs. affordability.
- Even if they do agree, are frameworks measuring the right attributes? Measuring all relevant aspects of treatment is time consuming and expensive. Complicating matters is the fact that not all data is always available, a study notes. Should value frameworks focus on “higher order utility” measures, such as quality of life, and skip safety measures, even though safety is more easily measured?
Recent interest in value-based health care comes amid sharp rises in prescription drug spending. In 2015, for example, U.S. national health care expenditures grew 5.8% to $3.2 trillion, while prescription drug spending increased 9.0% to $324.6 billion.
“The research presented in this supplement makes clear that value frameworks themselves have positive value,” says JMCP Editor-in Chief Laura Happe. “At the same time, there are fundamental issues with value frameworks that make expectations of a panacea unrealistic. We should be hopeful about the promise of value frameworks, even as we continue to ask and try to answer these hard questions.”