Health Technology Assessment and Value Frameworks to Inform Coverage Reimbursement

Topic(s):

Health Technology , Value-Based Care

In the transition from paying for the volume of health care to paying for value, health technology assessment (HTA) and value framework tools can serve as a resource for determining value of pharmaceuticals and other health interventions. Publicly available frameworks can provide valuable insights for health plans and PBMs as they evaluate appropriate use, coverage, and reimbursement for treatments. However, these tools must be based on sound methods using good scientific evidence and economic models, consider the totality of the evidence, incorporate the views of patients, and align value across stakeholders.

This Partnership Forum identified opportunities to improve how value assessments are developed and applied to formulary decision-making and provide strategies and guidance on best practices to equip managed care pharmacists and other professionals when applying these tools to assess value and optimize patient care.