26 July 2016 - Most health insurers don’t use value frameworks to when deciding which pharmaceuticals to cover and how much to pay for them, an analysis released today by Avalere Health shows.

Value frameworks, which are used to determine the value of a prescription drug based on its costs, as well as its benefits and how it improves a patient’s quality of life, were introduced by four high-profile organizations last year: the American Society of Clinical Oncology, the Institute for Clinical and Economic Review, Memorial Sloan Kettering and the National Comprehensive Care Network. Most payers told Avalere it was unlikely they would be using the framework initiatives to make decisions in their coverage a year from now.

Of the frameworks that were introduced last year, payers seemed to feel not optimistic about the models introduced by Memorial Sloan Kettering and the National Comprehensive Care Network. For both, 9 percent of respondents told Avalere they would very likely use their frameworks next year, 27 percent reported possibly using them and 64 percent reported they would likely not use them.

Read Morning Consult article