Dr Michael Sherman on Harvard Pilgrim's Work With Value Frameworks

Michael Sherman, MD, chief medical officer at Harvard Pilgrim Health Care, discusses how Harvard Pilgrim uses value framework during formulary deliberations to help make decisions, despite the fact that they only cover certain disease states right now.
Published Online: August 22, 2017


Michael Sherman, MD, chief medical officer at Harvard Pilgrim Health Care, discusses how Harvard Pilgrim uses value framework during formulary deliberations to help make decisions, despite the fact that they only cover certain disease states right now.

Transcript (slightly modified)
What has been Harvard Pilgrim’s experience with value frameworks?
I think value frameworks are incredibly useful. Again, we are in the early stages and they are somewhat controversial, depending who you ask, but I think having an objective measure of a drugs value is incredibly helpful. We use ICER [Institute of Clinical and Economic Review] and others in our formulary deliberations. They are not the decision-making body, so to speak, but they are one of many types of data that we look at.

There are challenges; for example, these frameworks do not cover all diseases, right now they don’t cover many disease states. They are only available in certain cases and one of the biggest challenges is that in this country, we don’t have any consensus on what is too expensive. So, if the output of these are some kind of fair market value that may help us frame a negotiation, but if there are no choices it may not. Again, in the United States, we are not willing to say that we are limiting access to a drug that’s effective solely because it is expensive.


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