Real-World Applications of the Value Equation in Cancer Care

Conference Correspondent - AVBCC 2019 Summit

With cancer drugs representing some of the most expensive pharmaceutical products on the market, conversations abound around value and proposed solutions for achieving it. Experts on the topic of drug pricing sat down during the AVBCC Summit to hash out which frameworks are best suited to real-world applications in oncology.

Peter Bach, MD, MAPP, Director of the Memorial Sloan Kettering Center for Health Policy and Outcomes, cited the National Comprehensive Cancer Network Evidence Blocks™ as a solid value framework, saying the tools have drug prices inversely associated with toxicity.

“I agree, it’s a little hieroglyphic,” he said. “That said, they’re not wrong. They’re certainly shedding some light.”

Dr Bach added that the Institute for Clinical and Economic Review (ICER) is the main player in the drug pricing and reimbursement arena. Using quality-adjusted life-years (QALYs) as the gold standard for measuring the effectiveness of a treatment, ICER faced some criticism because QALYs are not an equitable measurement for persons with cancer or other major illnesses. Therefore, ICER introduced the equal value of life-years gained, which would replace or augment QALYs, according to Surya Singh, MD, independent consultant and former Vice President and Chief Medical Officer of Specialty Pharmacy at CVS Health. Dr Singh acknowledged ICER as a consistent source for information on drug effectiveness and value.

The federal government is getting in on the action, as well, seeking to quell the high prices of drugs by several means. Introduced by House Speaker Nancy Pelosi, HR3 would allow the government to negotiate the Medicare price of up to 250 drugs. Members of the Senate Finance Committee have introduced their own, less aggressive drug-pricing bill, which would place a cap on annual drug-price increases and limit out-of-pocket expenses for Medicare beneficiaries. Meanwhile, the Trump administration has put forth the International Pricing Index (IPI) Model, for which a proposal is expected at some point.

Dr Bach warned that the House bill would threaten drug innovation, slowing down output.

“I don’t think Pelosi’s bill sees the Senate floor,” he added.

According to John O’Brien, PharmD, MPH, former Senior Advisor to the US Secretary of Health & Human Services on drug-pricing reform, both the House and Senate bills have areas where he would like to see improvements.

“I don’t like the fact that…therapeutic competition is left out of the discussion,” he said.

Dr O’Brien, who worked under both President Barack Obama and President Donald Trump, said the potential for these decisions to become politicized is a reality no matter which party is pushing the legislation.

In terms of the IPI, Dr Singh expressed disapproval of plugging into other countries’ processes for assessing value and questioned why the United States does not develop its own process.

It does not really matter which drug-pricing model is adopted, according to Larry Blandford, PharmD, Executive Vice President and Managing Partner at Precision Xtract. More interesting to consider is what these legislative measures will do to place pressure on drug manufacturers, he said. He used the analogy of e-prescribing, saying it was initially difficult to adopt but once it was adopted by some, others were forced to follow suit.

“The question becomes, ‘What are the bills and regulations that lead to the people here making this work?’” he said.