AMCP Partnership Forum Discusses Health Technology Assessment and Value Frameworks to Inform Coverage Reimbursement

Alexandria, Va., Sept. 8, 2022 — Last week, nearly 50 experts representing payers, pharmacy benefit managers, integrated delivery system leaders, employer benefit consultants, value assessors, researchers, pharmaceutical manufacturers, patient groups, and other key stakeholders in the managed care setting convened for AMCP’s Partnership Forum: Health Technology Assessment and Value Frameworks to Inform Coverage Reimbursement. The purpose of the forum was to identify how value should be rewarded amidst constrained resources as well as how to apply and improve value assessments and their use to inform formulary decision-making​. Participants also explored strategies, guidance, and best practices for managed care pharmacy when assessing value, a vital component of improving health system affordability and patient care across the country.  

Forum participants discussed the role of value assessment to identify patients for whom treatments are most beneficial and ensure products with fair value are available with streamlined patient access and lower out-of-pocket costs for patients. While value assessment does not address health system affordability, these results can serve as a tool to address health care costs and reward innovation. However, these assessments need to be transparent, based on a menu of core inputs and emerging endpoints such as patient perspectives and health inequities, updated, and dynamic as new information becomes available.  

The participants also discussed the many ways health technology assessment and value framework results are used in the formulary decision process and new approaches to inform risk-sharing agreements and benefit design. To improve the evolution, discussions focused on the need for additional education on value assessment application, improved data collection, expanded infrastructure and capacity for greater quantity and availability of information to produce and refine value assessment results, and communication best practices. 

“The role of health technology assessment and value frameworks in formulary decision-making continues to evolve as the focus on paying for value in our health-system escalates,” said AMCP CEO Susan Cantrell, RPh, CAE. “The participants at the Partnership Forum developed tangible steps to apply these tools for formulary decision-making as we strive to get patients the medications they need at a cost they can afford.”  

All findings and recommendations from the AMCP Partnership Forum: Health Technology Assessments and Value Frameworks will be published in an upcoming issue of the Journal of Managed Care + Specialty Pharmacy. In addition, AMCP will host a webinar in 2023 reporting the findings and recommendations. The event was sponsored by AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Genentech, Gilead Sciences, Inc., Horizon Therapeutics, Innovation and Value Initiative, National Pharmaceutical Council, Novartis, Novo Nordisk, PhRMA, Takeda, and Xcenda.  

About AMCP     

AMCP is the professional association leading the way to help patients get the medications they need at a cost they can afford. AMCP’s diverse membership of pharmacists, physicians, nurses, biopharmaceutical professionals, and other stakeholders leverage their specialized expertise in clinical evidence and economics to optimize medication benefit design and population health management and help patients access cost-effective and safe medications and other drug therapies. AMCP members improve the lives of nearly 300 million Americans served by private and public health plans, pharmacy benefit management firms, and emerging care models. Visit www.amcp.org.