ISSUE: There is increasing use of value assessment (e.g., reports issued by Institute for Clinical and Economic Review) throughout US health care. This issue panel will debate the appropriate role of these assessments in informing payer specialty drug in the US private sector. James Chambers will moderate and frame the issue by summarizing new research examining commercial payers’ reported use of value assessments in their specialty drug coverage policies. Susan Cantrell will address payer evidence requirements and how value assessments inform decision-making. Sara Traigle van Geertruyden will provide a patient’s perspective, and will discuss the need for clarity as to how payers use value assessments to guide patients’ access to medical technology. Randy Burkholder will describe how uncertainty in payers’ use of value assessment can lead to challenges in bringing innovations to the market.
OVERVIEW: In recent years value assessments have increasingly informed debate among patients, providers, payers and policy makers about the value of medical technology. However, how these assessments inform payer drug coverage policy is unclear. This panel will discuss research (based on a database of more than 4,000 drug medical policies) that has found variation in payers’ reported use of value assessments in their specialty drug coverage decision-making. The panel will debate whether the increased use of value assessments in the US reflects their greater influence, and whether their influence varies across payers. This issue panel will provide a forum to debate and discuss how value assessments can be used to complement other forms of evidence, and input from patients, to optimize payer decision-making. Panelists’ presentations will be limited to three PowerPoint slides, after which the moderator will encourage debate through Q&A and audience participation.