Managed Care - January 2008 - (Page 37) Plans Look Askance At Me-Too Medications Tougher standards being applied by insurers spur debate about what constitutes true value in a new drug have a fairly elaborate, but frequently not appropriately evidence-based, evaluation process in place for new therapies, notes Michael Stuart, MD, a ver the past six years, the Regence Group Group Health veteran who left to launch his own has employed pharmacists to sift consultancy — the Delfini Group — which adthrough all the data they can find on vises health plans and others on how they can judge newly approved therapies. They read a drug’s worth. the studies, both published and unpublished, mine “The idea of doing evidence-based medicine is the national databases, review FDA reports, evalunot unusual,” says Stuart about Regence’s approach, ate patient response rates, drug trial designs, and “but the rigor and expertise they have and the endpoints. Then they start making judgments on amount of energy they’ve expended in doing it what they’re worth. right is unusual.” Looking over the crop of new drugs approved in Regence, which operates Blue Cross and the 18 months leading up to last summer, Blue Shield plans in Oregon, Washington, Regence concluded that the class of Utah, and Idaho, includes its own claims 2006–2007 — for all the ballyhoo that often data in the evaluation and scrutinizes each surrounds their approval — includes a of the drug dossiers manufacturers are growing number of pharmaceuticals that asked to complete, using a format estabprovide very little added therapeutic value. lished by the Academy of Managed Care Many of these drugs don’t qualify for the Pharmacy. formulary. Stuart adds this proviso: Not everyone “That’s been a pretty significant trend can afford it. since 2000,” says Helen Sherman, PharmD, “Advertising fuels “You have to have a fairly big bank acthe chief pharmacy officer at Regence. the pipeline, to procount to pay for the staff to do this work, but “There are fewer and fewer products adding duce products that it pays off in the long run because of better value, and there are a number of drivers to- are similar but can still sell,” says outcomes for patients and frequently big ward that.” Helen Sherman, cost savings.” With headlines raising fears that some PharmD, the chief new drugs have been doing more harm than pharmacy officer at good, Sherman and other pharmacy direc- Regence. Some conclusions tors at the nation’s health plans have been After casting a wide net for drug inforcasting a skeptical eye on the scientific evidence. mation, Sherman’s team has reached a few concluThey’ve been steadily raising the bar for drug desions that many drug manufacturers would just as velopers as they try to sift therapeutic wheat from soon not hear. promotional chaff. In the process, the tougher stanIn a comparative analysis of drugs approved for dards being applied by managed care organizamarketing between January 2006 and July 2007, a tions have spurred a debate over what constitutes joint project between Regence and Blue Cross Blue value in a new drug and how you determine that — Shield of Michigan found that 69 percent involved with the stakes being raised significantly by a new a different chemical entity and a separate mechawave of pricey biologics that are just beginning to nism of action, but offered no clinical improvement spill out of drug developer’s pipelines. over other options already on the table. And while Most of the big, national health plans already 44 percent offered some new convenience — such By John Carroll O JANUARY 2008 / MANAGED CARE 37
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