Most health plans aren't using value frameworks to decide which prescription drugs they will cover, or how much to pay for them.
That's according to a new report from Washington, D.C.-based health care consulting comapny Avalere, which said that health plans are instead waiting for the frameworks to evolve and for physicians to buy in before they base decisions on them.
The framework initiative was launched in mid-2015 by the American Society of Clinical Oncology, Institute for Clinical and Economic Review, Memorial Sloan Kettering, and National Comprehensive Care Network as a means of helping stakeholders assess the value of drugs.
Recommended For You
The frameworks are used to assess the value of prescription drugs and other treatments based on clinical benefits, side effects, improvement in patients' quality of life and cost of the product.
While the health plans surveyed for the report regard the frameworks as useful in advancing the conversation about prescription drugs, none of the plans use them, feeling that they need to develop further before being adopted.
Providers need to adopt the frameworks, the plans said, before they themselves incorporate them into their decision-making process. That means that the plans do not think it likely that a year from now they will use the frameworks in making decisions on which drugs to cover.
Changes to the frameworks are being considered by some institutions or are already being incorporated. In May, the American Society of Clinical Oncology released an update to its value framework; in addition, the Institute for Clinical and Economic Review has recently released a solicitation for suggestions on how to improve its framework.
"Integrating broader perspectives of value — especially the patient's view — may help value frameworks garner greater acceptance," Josh Seidman, senior vice president of Avalere's Center for Payment and Delivery Innovation, said in a statement.
Seidman adds, "While current frameworks lay the groundwork for the continued push toward value, there's still room for improvement."
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
