Managed Care Pharmacy Issues

Welcome to the first Professional Affairs blog! We plan on sharing a periodic post to recap some of the major news, journal articles, reports, and other publications from around the web that have come out since our last post. As this is our first blog, we’ll try to adequately cover the whirlwind that was July and early August 2024.

Download the AMCP Engagement Framework at AMCP.org for Payers and Patient Organizations to find various resources, tools, examples, and instructions to guide payers and patient organizations in opening lines of communication to assist with incorporating the patient’s voice in decision-making processes.

PDTs offer significant promise in treating certain conditions and improving access to care, but participants agreed that a new modality requires new approaches to coverage. This brief is intended to help prepare the American health care system to begin covering PDTs.

The FDA continues to approve novel therapies, but concerns arise due to the costs of certain treatments. To address this, the AMCP organized a forum to explore solutions. Stakeholders recognize the benefits of high-investment medications, but uptake of payment strategies has been slow. Gradual changes, education, and collaboration are essential to improve predictability, affordability, and accessibility for patients.

AMCP convened key stakeholders in managed care to address the balance between patient access and payer requirements in the FDA Accelerated Approval (AA) pathway program. Experts from various fields participated, aiming to identify gaps between FDAAA requirements and payer-valued treatment outcomes, explore evidence ecosystem opportunities, and evaluate policy options. The forum emphasized supporting drug development innovation while recognizing payer needs and promoting stakeholder trust in the AA review process. Notably, incentivizing confirmatory trials emerged as a potential impactful policy solution.

Discover how health technology assessment (HTA) and value assessment frameworks play a crucial role in evaluating pharmaceuticals and health interventions. The recent multistakeholder Partnership Forum, hosted by AMCP, delved into recognizing value within resource constraints. Key takeaways include emphasizing innovative pharmaceutical products, comprehensive data, and the need for trusted value assessments in healthcare decision-making. Explore best practices for enhancing value assessment tools and processes across the industry.