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US Payer Perspectives on Evidence for Formulary Decision Making
Anthony Wang1, Ronald J Halbert, Tiffany Baerwaldt
1PriceSpective, Los Angeles, CA.
Journal of Oncology Practice
|September 4, 2012
Summary
Commercial payers desire more comparative effectiveness research (CER) for formulary decisions but find current CER lacking, especially in oncology. Collaboration on research and guidelines is needed to improve healthcare.
Area of Science:
- Health Services Research
- Pharmaceutical Policy
- Health Economics
Background:
- Comparative Effectiveness Research (CER) plays a crucial role in healthcare decision-making.
- Understanding the perspective of commercial payers on CER is vital for effective formulary management.
- Limited research exists on how commercial payers utilize and value CER in their decision-making processes.
Purpose of the Study:
- To explore the perspectives of US commercial payers regarding the use and value of CER.
- To understand how CER influences formulary decision-making across various disease states.
- To identify payer needs and preferences for CER study designs and applications.
Main Methods:
- Qualitative interviews were conducted with 20 medical and pharmaceutical directors from national and regional health plans.
- Participants rated the usefulness of different CER study types across diverse disease states and market conditions.
- Thematic content analysis was employed to interpret the interview data.
Main Results:
- Commercial payers expressed interest in a wide array of CER study types.
- Payers reported dissatisfaction with the current availability and quality of CER.
- A desire for collaboration with research groups to develop research and treatment guidelines was evident.
- CER was valued less in oncology compared to other disease states due to management limitations.
Conclusions:
- Policy makers should engage commercial payers in the development of CER.
- Involving payers in the creation of research and treatment guidelines can enhance formulary design.
- This collaboration can support payers in delivering more effective healthcare solutions.
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