Are We There Yet? Incorporating Value in Coverage Decisions

En route to summer vacations across the country, parents are hearing that all-too-familiar question: “Are we there yet?” It’s a question that also applies to our nation’s journey toward value-based care. Despite the history of health technology assessment (HTA) outside the U.S. and a decade of value assessment frameworks (VAF) inside this country, many stakeholders are asking, “Are we there yet?”
  
Patients must get the high-quality medications they need at a fair price, and HTA and VAF results can help. HTAs and VAFs are based on clinical, real-world, and patient-reported evidence. When based on sound methods, using good scientific and economic evidence, and focused on outcomes that matter to patients, VAF can accelerate the transition to paying for value. 
 
Additionally, consider the utility of value frameworks for managed care pharmacists as they assess value and optimize patient care. AMCP can help with tools. For example, the AMCP Format for Formulary Submissions, serves as a guide for communicating high-quality and sound evidence to inform value assessment. And educational sessions at AMCP’s national meetings and online through AMCP Learn offer members opportunities to learn about value assessments and the application to formulary coverage decisions.
  
Important journeys often have spirited debate. AMCP’s Journal of Managed Care and Specialty Pharmacy Perspectives on Value series has contributed in meaningful ways by publishing key value assessment reports, corresponding stakeholder perspectives and debate, and research to enhance value assessment methods.
  
Of course, uncertainties remain in value and fair pricing. For example, decision makers need to agree on the following: 

• What evidence should be considered in deliberations? 
• How are treatments for rare and ultra-orphan conditions valued? 
• What private or public organizations conduct assessments? 
• How are patient perspectives and health equity considerations incorporated? 
•  What optimal approaches ensure transparency and build trust in results? 
• Which elements of VAF results can Medicare and Medicaid incorporate? 

AMCP works to solve vexing health care obstacles. Consider, for example, AMCP Partnership Forums, which take on key health care challenges, discuss opportunities, and deliver tangible solutions. Findings and recommendations from the upcoming forum, “Health Technology Assessment and Value Frameworks to Inform Coverage Reimbursement,” will be presented in an upcoming issue of AMCP’s Journal of Managed Care + Specialty Pharmacy.  
 
In November, AMCP will host the Value and Access Summit. Your participation will help us as we progress toward our goals. Stay tuned to the AMCP website for more information about registration and sponsorship.  
 
I’ve shared with you just a few examples of the important work AMCP does. As managed care pharmacy professionals, you serve as stewards for high-quality and affordable care. Find out how AMCP can help you access and use important resources, like HTA and VAFs, to optimize value and access. Together, we will be able to announce, “We’re here!” on the journey toward value.