Kimberly Westrich Describes the Evolution of US Payers’ Views, Uses of Value Assessment Tools

In an interview at AMCP Nexus 2023 in Orlando, Florida, Kimberly Westrich, MA, of Cencora, explained the evolution of US payers’ views and uses of value assessment tools. Westrich was also a speaker during the session “Optimizing Value Assessment Tools for Coverage and Reimbursement Decisions: Promises and Pitfalls” on October 18, where she discussed the topic at length.

At Cencora, Westrich is a director of the value and access strategy team, where she leads projects relating to value assessment frameworks, specifically focusing on US markets and appraisals conducted by the Institute for Clinical and Economic Review (ICER).

Transcript

How have US payers' views and uses of value assessment tools evolved?

One of the things that we do at Cencora, we have a managed care network panel, which is a panel of US payers, and we talk to them regularly about important issues. Value assessment is something that we've been talking to the panel about since 2016.

Interestingly enough, familiarity with value assessments has increased from 2016 to 2018 to 2020. It's something that's been steadily growing, but their use has actually stabilized. When we look at the data, there was a big jump in use between 2016 and 2018, and this is when frameworks were really developing and starting to mature, but it's really stabilized since 2018.

What does that stabilization look like? ICER, the Institute for Clinical and Economic Review, is one of the most prevalent and most well-known value assessment frameworks, and we have 8 in 10 payers that are saying yes, we use ICER assessments to help inform our coverage and reimbursement decisions. Similar numbers say that they use ICER frameworks to inform their pricing negotiations.

Some interesting context to put that into context is that while we have all of these payers that are using ICER reports—they're a great compilation of all of the evidence that's out there—payers tell us that ICER reports are only 1 piece of information that they use in the world of value assessment. Specialty society guidelines were the highest source of valuable information in our survey, higher than ICER. Other things that were useful sources of information include AMCP [Academy of Managed Care Pharmacy] dossiers, some payers use international health technology assessment information, some payers use information that comes from PCORI, the Patient-Centered Outcomes Research Institute. So while payers are using ICER, it's only 1 piece of information that they're using in the broader universe.

A second thing that I want to say about ICER context is that ICER only does about 8 to 10 assessments each year. If you think about the FDA, it approves about 50 drugs per year, so there's only information from ICER that's available for really a subset of the new treatments each year. While payers can use it and it helps inform their decisions, it's only 1 piece of a broader group of information that they're using, and it's only available for a very small subset of the decisions that they're making each year.