Look behind the lecture: payer consideration of patient input

James Chambers (Tufts Medical Center; MA, USA) discusses his presentation at the Academy of Managed Care Pharmacy (AMCP) Annual Meeting (25-28 March, CA, USA) on payer consideration of patient input.

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May 08, 2019

Please introduce yourself 

My name is James Chambers and I am Associate Professor at Tufts Medical Center in Boston. I work in the Center for the Evaluation of Value and Risk in Health (CEVR) and my research largely focuses on how payers cover medical technology. We are currently finishing a study in which we examined what input patients currently have in specialty drug coverage policy decision making, and the benefits/challenges of formally including the patient’s perspective in the process. 

"...input from patients is invaluable in capturing ‘a day in the life’ of individuals..."

How do patient-reported outcomes (PRO) fit into current applications of real-world evidence (RWE)? 

I think that RWE offers important opportunities to collect PRO data and evaluate the impact of interventions on patients. While PRO data from randomized controlled trials (RCTs) is useful, PRO data from RWE is particularly valuable information that has the potential to improve clinical practice. 

A challenge is to ensure that we are collecting the right data: this is where input from patients is invaluable! 

What are the benefits of considering patient input into the development of drug coverage policy? In what form can patients currently contribute to these discussions? 

Considering input from patients is invaluable in capturing ‘a day in the life’ of individuals suffering from a particular disease. This information is difficult, if not impossible, to capture from traditional clinical studies and provides insight into what really matters to patients. 

"As researchers, we need to ensure that health plans have access to high quality data"

Patient input can take many forms, each with their own benefits and challenges. Large patient surveys would provide important empirical information but are costly and time consuming to conduct. Including a patient in the P&T committee is another option, and one that would provide the ‘a day in the life’ context mentioned above. However, this also has its challenges, for example representativeness. Other options would include gaining input from patient advocacy societies, although these can be viewed with skepticism if industry supported, or to lean on others’ attempts to capture patient values; some payers may rely on Institute for Clinical and Economic Review’s reports for such information. 

What are the existing obstacles in soliciting and applying patient input? 

In addition to what I’ve previously mentioned, our research identified the following: 

  1. Lack of understanding of the benefits of including patient input 
  2. The misconception that patients will only ask for better access, but at a lower cost 
  3. Currently, no suitable framework for including input from patients alongside empirical clinical data is available 
  4. Time and resources 

In your presentation, you noted that over 71% of respondents in a survey of health plan decision-makers felt it was “not probable” or “somewhat improbable” that patient/member input would increase in the future. From your personal experience, do you agree? 

I think this is a somewhat pessimistic, although understandable, view. My view is that health plan decision makers face an increasingly difficult task to provide patients appropriate access to specialty drugs, while controlling costs. They may see the formal inclusion of patient input as unwanted additional complexity. However, I believe that coverage policies should be an important mechanism that a health plan uses to ensure health plans are maximizing benefits for patients, and that incorporating input from patients can only improve decision making.  

"Patient input can take many forms, each with their own benefits and challenges"

As researchers, we need to ensure that health plans have access to high quality data, and that we have sufficiently nimble decision-making frameworks to allow for the incorporation of patient preference data. 

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