E.V.I.dently June 2019

Message from NPC

Why We Need to Consider the Proven Value of Drug Therapies

As we debate who and how we should pay for health care, it’s also critical that we make clear what we expect to get for those payments: high-quality, cost-effective care that improves patient outcomes — in other words, looking beyond cost to examine value. Although value may be difficult to define, it’s not impossible.

In his latest column for Specialty Pharmacy Times, National Pharmaceutical Council (NPC) President and Chief Executive Officer Dan Leonard explores recent research from the NPC and RTI Health Solutions that found biopharmaceuticals provide substantial health care benefits at modest cost — and that the reductions in mortality and morbidity in the top seven conditions causing death and disease between 1995 and 2015 show that spending on care for these conditions goes beyond cost and demonstrates value. Taken together with two other studies explored in the commentary, these research results provide powerful proof with which to challenge the conventional wisdom that all health care spending is out of control.

>> Read Mr. Leonard’s column in Specialty Pharmacy Times to learn more.

NPC Now: A Look at Our Latest Work

US Care Pathways: Continued Focus on Oncology and Outstanding Challenges

A peer-reviewed study published in the American Journal of Managed Care, conducted by NPC and the Analysis Group, assessed changes in development, implementation, and evaluation of care pathways, and reviewed the latest evidence on integration of pathways with value-based care initiatives in the U.S. The study found notable increases in process transparency, codification of standards, and prioritization of high-quality evidence, but additional improvements in transparency, including patient transparency, remain necessary.

NPC Comments on ICER’s 2020 Value Assessment Framework

NPC submitted comments to the Institute for Clinical and Economic Review (ICER) on ways to improve its value assessment framework and ensure that patient concerns are better addressed in treatment evaluations. The comments were grounded in NPC’s Guiding Practices for Patient-Centered Value Assessment, noting how ICER has three broad areas for improvement: modifications to its framework, enhancements to its assessment process and an expansion of its focus to include the entire health care system, rather than focusing solely on medicines.

NPC Submits Comments to CMS on Medicare’s New Technology Add-on Payment Pathway

Medicare’s new technology add-on payment (NTAP) program was designed to help Medicare more rapidly adjust hospital payments for new innovations, and the Centers for Medicare and Medicaid Services (CMS) is reviewing the criteria for services and technologies that qualify, including some medications. NPC suggested in comments submitted to CMS that the agency consider 1) broadening the use of clinical data considered as substantial clinical improvement, 2) expand its proposal for “breakthrough devices” to include breakthrough therapies, and 3) update payment mechanisms to include time to optimal uptake and the payment algorithm.

AMCP Accepts Comments for Updating Format for Manufacturer-Payor Communications

As part of its ongoing efforts to align with new federal guidance, the Academy of Managed Care Pharmacy (AMCP) released selected provisions from the Format for Formulary Submissions Version 4.1: Guidance on Submissions of Post-approval and Pre-approval Clinical and Economic Information and Evidence, an updated draft of its Format for Formulary Submissions, for public comment. NPC submitted comments on the proposed update this month, which you can read more about on NPC’s blog, as well as get information on NPC's researchprevious commentspartnerships and activities related to communicating evidence and information.

Research and Info You Need to Know

Rethinking Our Approach to Value Assessment to Ensure the Patient Voice is Heard

According to a panel at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Summit 2018 and summarized this month in Value in Health, even though value assessment frameworks are growing in use, these tools are not ready for “prime time” as they leave out critical considerations, including the patient voice. Learn what NPC Chief Science Officer and Executive Vice President Robert W. Dubois, MD, PhD, had to say about value assessment and moving beyond cost-effectiveness models as a panelist at the ISPOR summit in the Value in Health summary.

NAMI Highlights Concerns With ICER's Review of TRD

Andrew Sperling, Director of Legislative Advocacy for the National Alliance on Mental Illness (NAMI), discussed his organization’s experience in going through its second ICER value assessment review, this time for a new therapy for treatment-resistant depression. Read the full Q&A on NPC’s blog.

VBID Health Issue Brief Finds Pre-deductible Coverage for Existing Conditions Could Lead to Savings

An issue brief from VBID Health, found that allowing pre-deductible coverage for services or drugs intended to treat an existing illness, injury or condition could be cost-neutral, or potentially even offer cost savings, to the federal government. The brief, funded through an unrestricted grant from NPC, is a follow-on to an earlier VBID report on high-deductible health plans. The issue was the focus of an executive order signed on June 24 and newly introduced Senate legislation designed to allow pre-deductible coverage in HSA-HDHPs of chronic disease treatments.

ICYMI: Articles of Note

Events and Education

Webinar: “It Costs How Much?” Understanding Health Care Spending and Getting to the Root of the Problem

Join NPC and the National Alliance of Healthcare Purchaser Coalitions for a webinar on July 17 at 12:30 p.m. ET that will focus on how employers and other stakeholders are having difficult conversations that move us beyond our comfort zone, to a place where health care spending is optimized to improve patient well-being and health system efficiencies. Details and registration information are available on NPC’s website.