Value Tools in Managed Care Decision Making: Current Hurdles and Future Opportunities.

Area of Science:

• Health Economics and Outcomes Research
• Oncology Drug Management
• Payer Decision-Making

Background:

• Multiple organizations have developed oncology value assessment tools for various stakeholders.
• These tools were not specifically designed for payers, and their utilization in payer drug management processes is unclear.

Purpose of the Study:

• To identify which oncology value tools are used by payers in drug management.
• To understand the perceived benefits and shortcomings of these tools from a payer perspective.

Main Methods:

• A survey of drug coverage decision-makers at health plans was conducted in August 2016.
• Eligible respondents using multiple value tools participated in in-depth interviews to discuss tool attributes.

Main Results:

• 71% of surveyed payers use at least one value tool; 43% use two or more.
• Payers value tools for advancing discussions on drug value and incorporating clinical evidence.
• Shortcomings include variability in firm recommendations and price benchmarks; desired features include clear value positions, comparative data, web access, and quarterly updates.

Conclusions:

• While many payers use oncology value tools, significant opportunities exist to enhance their utility for payer decision-making.
• Payer-centric improvements are needed for tools to better support drug management processes.