What Payers are Thinking about Comparative Effectiveness

In March 2010, Xcenda conducted market research with payers who make product access decisions for 100 million covered lives. The research revealed the following insights related to comparative effectiveness research (CER):

• 46% of payers indicated that a database analysis of actual utilization data was their most preferred method to conduct a comparative effectiveness study, if a "head-to-head, double-blind, randomized controlled trial with active comparator" was not available.
  
  
• 81% of payers believe the importance of comparative effectiveness studies for decision making will increase over the next 2 years.
  
  
• 85% believe private payers will use comparative effectiveness data to require enrollees.... read article

How to Accelerate Commercial Success

Comparative effectiveness research (CER) is not only gaining focus from a legislative perspective—with over $1.1 billion allocated to CER by a recent economic stimulus plan—but is also seeing increased focus among managed care decision makers. In a March 2009 managed care survey, 3 out of every 4 managed care decision makers reported that comparative effectiveness was best defined as head-to-head, double-blind, randomized controlled trials (RCTs) (MCN 2009). However, approximately 90% of those surveyed deemed the availability and accessibility of such trials inadequate.

In the absence of available RCTs, 1 out of every 2 managed care decision makers deemed retrospective claims database analyses as the most preferred approach in conducting comparative effectiveness studies (MCN 2010). Retrospective claims data have been frequently used by managed care organizations to evaluate....read article

What Oncologists are Thinking about Comparative Effectiveness

Growing consensus is that comparative effectiveness (CE) is needed in oncology due to the rise in available diagnostic and treatment options. The Agency for Healthcare Research and Quality (AHRQ) has already started down this path with CE research in the areas of prostate, breast, and head/neck cancers. CE research could also affect oncology reimbursement by impacting decisions on the issuance of new codes (eg, HCPCS) for new oncology therapies¹. But what do providers know about CE, and how are they likely to be impacted by payers’ approaches to CE?  read article

Healthcare Reform Update

As reported in the May 7 edition of Health Policy Weekly, CMS issued draft guidance on Part D 50% brand name discount program....... read article