“Oncology is a fast-moving field and the arrival of value frameworks marked the first time payers in the U.S. had credible tools to assess oncology drug value,” Schafer says. “Knowing that payers would be interested in these frameworks, we wanted to understand how payers are using them and also understand payer perceptions into the strengths and weaknesses of each framework.
"In addition, since none of the frameworks were specifically designed to inform coverage decisions, we wanted to understand what payers would like to see if there was a ‘payer-centric” value framework designed in the future,” he says.
The value frameworks provide some guidance on assessing the value of oncology therapies and are being supported in some cases by leaders in oncology like NCCN and ASCO, says Schafer.
“Payers appear to be increasingly using these frameworks as part of their decision-making process," he says. "However, payers also seem aware of some of the shortcomings of each framework. It is important for managed care execs to understand the positives and negatives of these frameworks so that coverage decisions are not made based on erroneous assumptions.”
In addition, the frameworks may be useful guidance to health systems and integrated delivery networks, according to Schafer. “With the Oncology Care Model (OCM) there is a growing push to consider cost in oncology management. Health systems and payers participating in the OCM are thus incentivized to pick the highest-value therapies. The value frameworks may offer some insights on that.”