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Value Assessment Framework Effects on Payer Coverage Decisions

November 06, 2019

In a poster presentation at AMCP Nexus 2019, researchers presented findings from two surveys examining how value assessment frameworks (VAFs) are impacting payer coverage decisions in the United States.

Two double-blind, web-based surveys, sponsored by Xcenda, were completed by managed care professionals in 2016 and 2018 where respondents were asked to share their perceptions and use of the Institute for Clinical and Economic Review (ICER) VAF, the Memorial Sloan Kettering Cancer Center (MSKCC) DrugAbacus tool, and the National Comprehensive Cancer Network Evidence Blocks (NCCN-EB)

“Payer utilization of VAFs to inform coverage decisions generally increased from 2016 to 2018, though the use of specific aspects of some VAFs decreased,” explained the researchers. “The key attributes of VAFs valued most by payers remained largely consistent over time.”

Survey respondent data showed an increased use of economic data from the ICER VAF (32% in 2016; 98% in 2018) and clinical data from NCCN-EB (63% vs. 98%) to inform decisions over the 2-year period.

Utilization of the MSKCC DrugAbacus decreased significantly during the time period for both economic and clinical data, 14% to 2% and 14% to 5%, respectively.

According to the researchers, “The percentage of payers using VAFs for patient preference data increased over the 2 years for the ICER VAF (11% vs 23%).”

When asked why payers choose not to use VAF to inform decisions, the most common response was insufficient validation of the framework, that it is cumbersome and difficult to use, and a need for a revised version of VAF.

Further, “When asked to describe changes needed for future VAFs, payers cited similar features at both time points, including the need for: (1) more objective outputs; (2) more emphasis on the payer perspective; and (3) a simpler design/scoring system.”

“As the VAF landscape continues to evolve and shift, it is essential that payers actively engage in shaping it based on experience to ensure that the tools will be meaningful and fit-for-purpose to inform coverage decisions,” concluded the researchers.

—Edan Stanley

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