The Journal of Managed Care & Specialty Pharmacy this week published the proceedings from the Academy of Managed Care Pharmacy partnership forum, “Driving Value and Outcomes in Oncology,” which focused on the challenges with value assessment, balancing population health and personalized medicine, and value-based contracting for oncology medicines. The National Pharmaceutical Council’s Kimberly Westrich, vice president for health services research, was a panelist at the forum, which was attended by representatives from health plans, PBMs, clinical practice and biopharmaceutical companies.
Among the highlights from the forum proceedings:
Value assessment: Participants noted that value assessment frameworks are “not ready for prime time,” pointing out that the frameworks are already in use but there is “confusion about who should use the tools, how they might be utilized, and even in which direction they are taking payers, providers and patients.” The findings align with NPC’s work on measuring and defining value, which emphasizes the need to incorporate the full value and benefits of medical innovation, as well as the patient's input, in an assessment framework.
Value-based contracting in oncology: Participants suggested that for payers and biopharmaceutical manufacturers to engage effectively in contracts that provide payment based on how well a product performs for a particular patient population, regulatory changes may be needed. Barriers that could be addressed include those related to Medicaid best price, the anti-kickback statute, and limitations on information sharing between payers and manufacturers. NPC’s research has found that data is being used to facilitate value-based contracting between health plans and providers or biopharmaceutical manufacturers.
Precision medicine in oncology: Forum participants noted that precision medicine clinical trials include relatively small numbers of patients, resulting in a limited evidence base for guiding care decisions. That limited base can be supplemented with real-world evidence, which investigates how treatments work in the real world under usual care settings. The proceedings suggested this real-world evidence base can “be bolstered through reporting systems that capture data and outcomes from daily practice.”
NPC sponsored the partnership forum, along with several other health care-related organizations.
For more information on value in health care and assessment frameworks, view materials from NPC’s Assessing Value: Promise & Pitfalls conference, which brought together health care stakeholders to discuss research and ways to move the value field forward, and our recent webinar on improving oncology quality measurement.