Payers want more data for drug coverage decisions


Payers need more outcomes data--clinical, economic and humanistic--from drug manufacturers for more informed decision-making, Managed Health Executive reported.

With increasing costs, less drug exclusivity, technology advancements and growing expectations for transparency, better outcomes data will allow health insurers to optimally allocate resources. Moreover, the move to accountable care creates a need for more outcomes data, as payers must take on more risk and show "rational" management decisions, the article noted.

"Manufacturers are mostly focused on product development, safety, clinical efficacy and regulatory approval, but now payers are demanding more data to effectively assess drug costs and outcomes," Nathan White, director of medical communications company NucleusX Market Access, said at the Academy of Managed Care Pharmacy's annual meeting last week.

Although payers lack the resources to conduct their own research, they still have doubts about the credibility of pharma-provided clinical outcomes information, according to the American Journal of Managed Care.

To ease credibility concerns, payers can combine resources and form regional coalitions that analyze health outcomes data. They also can contribute more to the creation of health outcomes study design standards, the AJMC noted.

"The United States is five years behind Europe and Australia in setting requirements for presenting health economic data and outcomes," said White. "These other countries have already established a collaborative, transparent process for disseminating information, while providing an opportunity for dialogue prior to a clinical development program."

To make good business decisions around pharmacy, Boston Medical Center HealthNet Plan has been investing in enhanced analytics tools. Recognizing that a small population of members using an expensive drug can have a significant increase on the pharmacy trend, the 350,000-member health plan has been looking at the cost and utilization of Sovaldi, for example, the new hepatitis C medication that costs $84,000, Lisa Feingold, vice president of Clinical Informatics at BMCHP, told FierceHealthPayer last week in an exclusive interview.

To learn more:
- here's the Managed Health Executive article
- read the AJMC article

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