Through this challenging year, we’ve been especially gratified to see that the National Pharmaceutical Council’s health policy research has remained relevant and impactful. In particular, we were pleased that NPC’s work was the most broadly featured in the Journal of Managed Care & Specialty Pharmacy’s 12-part 25th anniversary series featuring “topics of significance” in managed care.
Exchange of Information Between Biopharmaceutical Manufacturers and Payers
Payers need high-quality evidence to make sound, informed decisions about the types of health care treatments and diagnostics that they will cover. NPC has long been engaged in peer-reviewed research on this topic, and our staff regularly works with outside organizations, including the Academy of Managed Care Pharmacy (AMCP), to improve research methods and the exchange of health care information. Since 2000, AMCP’s Format for Formulary Submissions has provided a “best practice guidance for transmission of evidence from manufacturers to health care decision makers,” a point highlighted in a June featured article.
The Format has continued to adapt to the changing health care environment, such as addressing legal and regulatory concerns, clarifying language to increase stakeholder acceptance, and transitioning from a paper-based system to an online one.
NPC’s research has helped to inform some of these updates, and NPC Vice President of Policy Research Jennifer Graff, PharmD, has served on AMCP’s Format for Formulary Submissions Executive Committee. She also contributed as a coauthor of the article in JMCP.
Accountable Care Organizations and Medication Use
In November, JMCP reprinted NPC’s 2014 study, “Are ACOs Ready to Be Accountable for Medication Use?” which measured the ability of 46 accountable care organizations to “maximize the value of medications to achieve quality benchmarks and costs offsets.” In a companion article, NPC Vice President for Health Services Research Kimberly Westrich and Consultant Lisabeth Buelt reflected on the progress that ACOs have made since that time. “Accountable care models have advanced not only in number but also in sophistication, and ACOs have made incremental progress toward achieving medication optimization in select areas,” they wrote.
This progress is especially important for patients. “Given the vital role and value of medications in treating chronic conditions and other diseases, optimizing medication use inside and outside of accountable care environments can help improve patient outcomes and contain costs,” Westrich and Buelt wrote.
Use of Real-World Evidence in Decision-making
Finally, in December, NPC’s work on real-world evidence (RWE) was spotlighted through a reprint of the article, “Is Real-World Evidence Used in P&T Monographs and Therapeutic Class Reviews?” and a reflection by one of the study’s authors, University of Arizona College of Pharmacy Professor Dan Malone. The study found that payers infrequently used RWE, or information on how treatments work in the real world, to guide their medication coverage and reimbursement decisions. Since the 2017 study, RWE has been growing in use, fueled by improved collection of real-world data, methods and analyses. As Malone noted, the earlier study set a baseline for understanding whether RWE is being used and the barriers to its broader consideration in decision-making.
NPC remains committed to policy research that addresses questions facing our health care system today, so that we’ll be better prepared to tackle the challenges of tomorrow. We congratulate JMCP on 25 years of publication, and we look forward to continuing our research informing important dialogues in managed care that we hope will be just as relevant in the 25 years to come.