Real-World Applications of Value-Based Care in Oncology

TOP - March 2020, Vol 13, No 2 - AVBCC 2019 Highlights, Value-Based Care

New York City, NY—With cancer drugs representing some of the most expensive pharmaceuticals on the market, conversations abound around value in oncology and proposed solutions for achieving it. At the 2019 AVBCC Summit, experts on the topic of drug pricing hashed out which frameworks are best suited for real-world applications in cancer care.

Peter Bach, MD, MAPP, Director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, cited the NCCN Evidence Blocks as a solid value framework, saying that these tools have drug prices inversely associated with adverse events.

“I agree, it’s a little hieroglyphic,” he said. “That said, they’re not wrong. They’re certainly shedding some light.”

Dr Bach added that the Institute for Clinical and Economic Review (ICER) is the main player when it comes to drug pricing and reimbursement. Using quality-adjusted life-years as the gold standard for mea­suring the cost-effectiveness of a treatment, ICER faced some criticism, because quality-adjusted life-years are not an equitable measurement for patients with cancer or for other major chronic diseases.

Therefore, ICER introduced the measurement of life-years gained, which is intended to replace or augment quality-adjusted life-years, according to Surya Singh, MD, former Vice President and Chief Medical Officer, Specialty Pharmacy, CVS Health. Dr Singh acknowledged that ICER is a consistent source for information on drug cost-­effectiveness and value.

Pending Drug-Pricing Legislation

The federal government is getting in on the action as well, seeking to quell the high prices of drugs by several means. Introduced by House Speaker Nancy Pelosi, the H.R.3 bill—Lower Drug Costs Now Act of 2019—would allow the Centers for Medicare & Medicaid Services to negotiate the drug prices for up to 250 Medicare drugs that are the most costly medications. Members of the Senate Finance Committee have introduced their own, less-aggressive drug-pricing bill, which would place a cap on annual drug-pricing increases and limit out-of-pocket expenses for Medicare beneficiaries. Meanwhile, the Trump Administration has put forth the International Pricing Index Model.

Dr Bach warned that the H.R.3 bill would threaten drug innovation, slowing down the development of new drugs, which would clearly affect cancer drugs.

“I don’t think Pelosi’s bill sees the Senate floor,” Dr Bach added.

According to John O’Brien, PharmD, MPH, former Senior Advisor to the US Secretary of Health & Human Services on drug-pricing reform, the House and the Senate bills have areas where he would like to see improvements.

“I don’t like the fact that…therapeutic competition is left out of the discussion,” he said.

Dr O’Brien, who worked under President Obama and President Trump, said that the potential for these decisions to become politicized is a reality, no matter which party is pushing the legislation.

In terms of the International Pricing Index, Dr Singh expressed disapproval of plugging into other countries’ processes for assessing value, and questioned why the United States does not develop its own value process.

It does not matter which drug-pricing model is adopted, according to Larry Blandford, PharmD, Executive Vice President and Managing Partner at Precision Xtract. It is more interesting to consider how these legislative measures will place pressure on drug manufacturers, he said.

Dr Blandford used the analogy of e-prescribing, saying it was initially difficult to adopt, but once it was adopted by some prescribers, others were forced to follow suit.

“The question becomes, ‘What are the bills and regulations that lead to the people here making this work?’” Dr Blandford said.

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Last modified: May 6, 2020