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Video Transcript: Clarity on Comparative Effectiveness: How and When Will It Be Used by Payers

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Gina: Comparative effectiveness. Utilization and cost management. Quality of care. What answers are pharmaceutical manufacturers coming up with to confront ongoing questions over these issues. Join us to find out. “In the Know” starts now.

Hello and welcome to “In the Know,” your source for insight and analysis on the issues that matter to specialty pharma. I’m your host, Gina Clark.

Today, we’re expanding our conversation around comparative effectiveness, a topic that strikes equal parts apprehension, uncertainty, and even fear in the minds of many within healthcare. We touched briefly on the subject in our last webisode, and joining us once again to provide even grater clarity around comparative effectiveness is Bob Mauch, president of Xcenda. Bob, thanks for joining us.

Bob: Thank you, Gina.

In our last webisode, you gave us some insight for how you believed comparative effectiveness will be rolled out in the United States. How do you think it will compare to what we will see in Europe and Canada?

Bob: Well Gina, that’s a big debate right now. The main difference between what we will see in Europe for example, in the U.K. is a centralized comparative effectiveness activity where comparative effectiveness data are submitted to the government, and then the government makes approval decisions based upon that. What we have here in the United States is a de-centralized process right now, where payers, both public and private, are searching for comparative effectiveness information, and then they will implement that within their populations. The questions as we go through the health reform process are whether there will be some centralized process.  

What lessons can pharma companies learn from comparative effectiveness in other countries?

Bob: I think the most important lesson is to be involved now and be a participant in the process. The best way for the pharmaceutical industry to stay ahead of the curve, if you will, in terms of comparative effectiveness, is to be part of the process, be part of the group that determines what comparative effectiveness guidelines should be, what data should be used, how it should be funded, and really who should control the studies. If they’re a part of that process, then they are going to be in the best position to make sure their products are appropriately represented, and therefore patients will have access.

Do you feel that there may be gaps in what public and private payers envision for comparative effectiveness, and what can actually be implemented? For example, I know there are a number of questions that are yet to be answered about what data will be required and how it will be collected.

Bob: Yeah, I don’t think there are real gaps between the two. I think a payer, whether that’s a public payer or a private payer, wants to provide quality, and we hope very high quality, in the most cost effective way. So really, private and public payers are looking for the same thing. Where that gets difficult, is where we start to look at tradeoffs and if we’re looking to potentially reduce quality slightly for less money, that’s when the conversation gets very difficult. If we assume the current model, which is very high quality, and how can we do that for the lowest possible cost. And I think public and private payers really would be seeking the same information.    

What about provider and patient reactions? In what ways are these groups’ concerns being addressed? 

Bob: I think you know that it comes down to the concerns around that I just mentioned. And when you start to tradeoff quality for cost, then that’s where we have to discuss rationing really from both a patient perspective and a physician perspective that’s very concerning.

Bob, do you have any other thoughts regarding comparative effectiveness within the current healthcare reform environment?

Bob: Gina, comparative effectiveness is still a big part of the process, and as you know the healthcare reform situation is changing on a daily basis. So I think what’s most important is that we remember two things. One is we need to keep our eye on what’s happening, and there is a significant possibility that there will be some sort of federally funded comparative effectiveness initiative that comes out of the healthcare reform process. The second thing that’s also very important to remember is that comparative effectiveness is here to stay, without regard to any federal funding. Payers, both public and private really need to understand comparative effectiveness, and they will continue to invest in those initiatives as we go forward.    

Setting comparative effectiveness aside, what other utilization and cost management strategies in the specialty space are you seeing gain more traction among public and private payers? What steps can manufacturers take to address this?

Bob: I think one of the most interesting is the fact that payers are now willing to implement utilization management programs within cancer care. That’s something that even 3-5 years ago really wasn’t something that you would hear about, and now we have payers partnering with physicians and sometimes with other organizations to implement utilization management around cancer care, really with the goal of decreasing variation in care. For the pharmaceutical industry it’s not really a change outside of what’s already going on because it’s a little controversial to talk about utilization management in cancer care, but really what payers are looking for is cost effective care, so they want appropriate utilization, and they want providers to be able to measure the impact and the outcomes that they get from that care. So as long as they follow those three simple steps that we’ve talked about, they’ll be fine. And that is make sure they have information that is useful to payers within their clinical trials. Make sure they really understand the value that their product brings and be able to communicate that clearly to payers and providers. And lastly, make sure that they have programs in place to overcome any utilization barriers in the marketplace, such as reimbursement barriers or adherence barriers.   

I see that we’re running short on time. Once again, terrific insight. Thank you for your thoughts on this crucial issue.

Bob: Thank you, Gina.

And thank you for joining us—we’ll be back soon with another, all-new webisode. Until then, if it’s on your mind, it’s In the Know.

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