Managed Care Outlook

Comparative effectiveness to play greater role

The majority of respondents to a survey that examined comparative effectiveness (CE) research and biologic agents predicted that within the next five years, CE research will be required to support coverage decisions concerning biologic therapies. The results were published in the 2009 Biotechnology Monitor & Survey: Marketplace Policies, Practices, and Perspectives.

In 2008, 17 percent of Medicare Advantage plan pharmacy and medical directors performed therapeutic outcomes studies to assess biologic therapies in their own organizations. Thirty-nine percent plan to conduct CE research in 2009.

Marsha Fahey, managing editor and research director of the survey, says, “It’s a sign that there’s a lot of attention being paid to biologics.” Is it too late for health plans that haven’t started conducting this research? “Health plans haven’t missed the boat,” she says. “A lot more data will be available from CMS soon.”

She notes that oncologists are much more familiar with CE research. “Comparative effectiveness forms protocols and guidelines. The National Comprehensive Cancer Network, an alliance of 21 cancer centers, has been using it for a long time, and most oncologists look at those evidence-based guidelines to make decisions,” says Fahey.

Health plans’ involvement in CE research

Source: 2009 Biotechnology Monitor & Survey: Marketplace Policies, Practices, & Perspectives


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