Implementing CER: what will it take?

Area of Science:

• Health economics and outcomes research
• Pharmaceutical policy and management
• Health services research

Background:

• Comparative Effectiveness Research (CER) is increasingly influencing drug development, pricing, and reimbursement in the US.
• Organizations are actively assessing the utility and integration of CER data into their decision-making processes.
• A stakeholder roundtable, including formulary decision makers, explored CER's impact on managed care organizations (MCOs).

Purpose of the Study:

• To analyze the role of CER in current formulary decision-making.
• To compare CER with existing modeling techniques.
• To identify future applications and funding sources for CER.

Main Methods:

• A roundtable discussion with key stakeholders, including formulary decision makers and representatives from pharmacy benefit management (PBM) companies.
• Evaluation of current practices and future potential of CER in managed care.
• Discussion on necessary infrastructure and policy changes for CER integration.

Main Results:

• Most stakeholders recognize CER's value in improving formulary decision-making, despite varying definitions.
• CER can inform coverage decisions related to benefit design, contracting, and alternative pricing.
• Enhanced health information technology infrastructure is crucial for capturing value-related data in CER.

Conclusions:

• CER is expected to become a more significant component of formulary decision-making.
• Successful future integration of CER requires federal and academic leadership, improved health IT, sustained funding, and standardized methodologies.
• CER application is essential for determining drug value and cost-effectiveness.