Currently Viewing:
AMCP 2017
Currently Reading
Dr Jennifer Graff on How Payers Make Decisions
August 01, 2017
Dr Jacqueline Glover: Financial Knowledge Is Part of Informed Consent
July 10, 2017
Laura Topor Explains the Value of Real-Time Benefit Transactions
June 27, 2017
Dr Jacqueline Glover: Clinicians' Obligations of Justice Regarding Costs of Care
June 24, 2017
Dr Lou Garrison Discusses Challenges of Working With Real-World Data
June 16, 2017
Dr Neil Minkoff Explains How 340B Impacts Pharmacies and Payers Differently
June 15, 2017
Dr Matthew Pickering on Working With Health Plans on Measure Implementation
June 09, 2017
Laura Topor: Clearing Up Misconceptions About e-Prescribing
June 07, 2017
Dr Jacqueline Glover Discusses the Complicated Balance of Ethics in Drug Trials
June 05, 2017
Dr Richard J. Willke Discusses Challenges of Working With Real-World Data
June 02, 2017
Susan A. Cantrell Explains the Necessity of Pre- and Post-Approval Communications
May 31, 2017
Dr Neil Minkoff Discusses Evolution and Consequences of 340B Programs
May 30, 2017
Dr Doug Hillblom Discusses Legislative Pushes Toward e-Prescribing
May 25, 2017
Dr Matthew Pickering Describes Challenges of New Measure Implementation
May 24, 2017
Dr Aimee Tharaldson Discusses the Orphan Drug Approval Trend
May 22, 2017
Dr Gail Bridges on the Importance of Real-World Results Matching Clinical Trial Outcomes
May 21, 2017
Dr Liz Zhou Discusses Real-World Implications of Toujeo Switching Trial
May 19, 2017
Dr Richard J. Willke on the Value of Real-World Data for Health Plans
May 18, 2017
Dr Lou Garrison on the Discussions Surrounding Outcomes-Based Arrangements
May 17, 2017

Dr Jennifer Graff on How Payers Make Decisions

Jennifer Graff, PharmD, vice president of comparative effectiveness research at the National Pharmaceutical Council, discusses where payers receive their information and how it is used to make decisions about coverage and reimbursement.


Jennifer Graff, PharmD, vice president of comparative effectiveness research at the National Pharmaceutical Council, discusses where payers receive their information and how it is used to make decisions about coverage and reimbursement.

Transcript (slightly modified)

What forms of evidence are considered optimal in order to make informed decisions related to coverage and reimbursement?

Payers use a wide variety of information to make coverage and reimbursement decisions. They use the best available information to try to determine safety, effectiveness, which treatments work best for which patients, and how a treatment compares to other treatment alternatives. This best available evidence could take many forms and could include FDA information, manufacturer supported information, clinical trials, real-world evidence, and cost-effectiveness. We know this by peeling back the onion to try to understand not only what payers say they do and utilize, but also looking at P&T monographs or looking at medical coverage policies to understand what types of evidence they cite. It’s a wide variety of types of information and often very desperate.

The challenges that many payers have is that what they would optimally like to have may not always work out in the real world. There’re timing issues and they have to make a decision within the first 90 days that a product is available, so all the information about how a treatment works in the real world isn’t often available. They have staff and resource issues to try to evaluate all of the different types of information and there are also issues about what information can be available and when. So, what payers are looking for, really is optimally a wide variety of information. What is used can change from payer to payer, and may not always reflect the real-world.

 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!