E.V.I.dently November 2019

Message From NPC

NPC Welcomes New Board Leadership

The National Pharmaceutical Council (NPC) announced that Blasine Penkowski, MBA, Chief Strategic Customer Officer of Johnson & Johnson Health Care Systems Inc., has been elected Chair of NPC’s Board of Directors for 2019-2020. Speaking about the newly-elected Executive Committee and board-level leaders, NPC’s President and CEO Dan Leonard, MA tweeted, “@npcnow has benefited from the vision and commitment of our board leaders. So pleased our work continues to be driven by a remarkable group.” See the release and be sure to follow NPC and Mr. Leonard on Twitter.

NPC Now: A Look at Our Latest Work

New NPC Study Shows Little Consistency in Evidence Cited by Commercial Health Plans for Specialty Drug Coverage

Given the influence that health coverage can have on a patient’s access to care, how well are health plans aligning their coverage decisions to evidence? New research from NPC and the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, published in November’s Health Affairs, revealed significant variation in the consistency, volume and type of evidence being cited in coverage decisions for specialty medicines. Study authors found that only 15 percent of the health plan coverage policies cited the same study for any given drug and disease pair. Read more about the study.

Going Below The Surface Forum Launches with Focus on Low-Value Care

On Nov. 6, the Going Below The Surface (GBTS) Forum, representing patient groups, providers, payers, employers and life science organizations, announced a series of efforts aimed at tackling U.S. health spending issues. Among initial initiatives, the Forum will address low-value care and plans to launch a step-by-step guide for use by health care stakeholders as they consider and implement interventions to reduce use of low-value care. The topic of low-value care also was discussed during two regional town halls, held in Columbus, Ohio on Nov. 6, and in Salt Lake City, Utah on Nov. 7. Read more and subscribe to the GBTS monthly e-newsletter dedicated to news, research and analysis on health spending.

NPC and PQA Call for Research Proposals on Barriers to Medication Access

NPC and the Pharmacy Quality Alliance (PQA) announced a new funding opportunity, aimed at supporting research to identify systemic approaches for lowering barriers to medication access, including research that examines the role of quality measures, social determinants of health and new models of care delivery. The research projects will build on the NPC-supported PQA publication of the Medication Access Patient Journey Framework, which identified seven main steps in the medication access journey and the structural, financial and personal barriers patients face within each.

As Interest in Value Assessment Grows, NPC Shares New Analysis

NPC shared its newly-released analysis, Current Landscape: Value Assessment Frameworks, with attendees of recent conferences including the 15th Annual Personalized Medicine Conference at Harvard Medical School in Boston, MA, the 2019 STAT Summit, also hosted in Boston and the National Alliance of Healthcare Purchaser Coalitions Annual Forum in Washington, D.C. The analysis examines existing frameworks through the lens of six broad categories: development process, measures of benefit, measures of cost, methodology, evidence and assessment process. The analysis asserts that there is no “best” framework and that health care decision-makers should rely on multiple frameworks and tools to assess value, rather than looking to a single framework to inform health care decisions.

Other Research and Info

ICER Seeks to Widen Its Focus to Non-Drug Topics

On Nov. 13, the Institute for Clinical and Economic Review (ICER) issued a call for public input to help identify non-drug topics for ICER assessments in 2020. Expanding the focus of value assessments to the entire health system reflects NPC’s June 2019 comments regarding the ICER 2020 Value Assessment Framework and a long-standing recommendation that value assessment reflect the full range of health interventions, not just biopharmaceuticals, which represent a limited portion of the overall health care budget. 

NPC Submits Comments to CMS on Medicare Program Integrity

In response to an RFI from the Centers for Medicare and Medicaid Services (CMS) regarding the future Medicare program integrity. NPC submitted comments focusing on ways to improve prior authorization within the Medicare Fee for Service program. As the agency looks at next-generation strategies, tools and technologies, the comment letter highlighted NPC research that demonstrates wide and varied use of step therapy in commercial health plans, illustrating challenges patients face in accessing medicines. Additional research by NPC shows that while stakeholders disagree on when to use step therapy, there is broad agreement on how to develop, implement, communicate, and evaluate step therapy policies and protocols. Read NPC’s comments here.

Employers and Payer Consider Strategies for Eliminating Low-Value Care

NPC’s Mr. Leonard joined health leaders at the Nov. 11-13 National Alliance of Healthcare Purchaser Coalitions Annual Forum in Washington, D.C. to discuss strategies for eliminating low-value care while incenting high-value care in health benefits, highlighting discussions driven by NPC’s Going Below The Surface initiative. The panel was moderated by the National Alliance’s Chief Medical Officer, Bruce Sherman, MD, FCCP, FACOEM, and included Mark Fendrick, MD, director of the University of Michigan’s Center for Value-Based Insurance Design and Beth Bortz, president and CEO of the Virginia Health Innovation Center.

ICYMI: Articles of Note

  • Anirban Basu, PhD; Richard Grieve, PhD; Daryl Pritchard, PhD; and Warren Stevens, PhD. Commentary: One Size Does Not Always Fit All in Value Assessment. November 2019, The American Journal of Managed Care
  • Valuing A Cure: Final White Paper and Methods Adaptations. November 12, 2019, ICER
  • Huls SPI, et al. What Is Next for Patient Preferences in Health Technology Assessment? A Systematic Review of the Challenges. November 2019, Value in Health
  • David M. Kent, MD, MS, et al. The Predictive Approaches to Treatment Effect Heterogeneity (PATH) Statement: Explanation and Elaboration. November 12, 2019, Annals of Internal Medicine
  • Joshua R. Zadro, et al. Do Choosing Wisely Recommendations about Low-Value Care Target Income-Generating Treatments Provided by Members? A Content Analysis of 1293 Recommendations. November 11, 2019, BMC Health Services Research

Post-doctoral Fellowship Opportunity

Accepting Applications for Post-Doctoral Health Policy Fellowship

NPC, in partnership with the Duke-Margolis Center for Health Policy, is accepting applications for a post-doctoral fellowship in health policy based in Washington, D.C. and will begin reviewing applications on January 15, 2020. The fellow will have the opportunity to explore the policy implications of health services research, design studies to help inform policy options and engage with a diverse set of stakeholders in Washington, D.C., and at Duke University.