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Determining Formulary Value
Transcript of Determining Formulary Value
However we all agree that it is important.
In managed care, we want our formulary to reflect value.
But... Process & Methods An Example... So.... Photo credits: 'delicate arch' by Andrea Goldstein $ Adam Wolfe
Pharm.D., candidate 2011 ...and pay off our risk! Discussing value in managed care The American Journal of Pharmacy Benefits, Volume 2 Number 3; 2010
CEA Registry, www.cearegistry.org, accessed September 15, 2010 ISPOR, Volume 13 Supplement 2; 2010 The American Journal of Pharmacy Benefits, Volume 2 Number 3; 2010
CEA Registry, www.cearegistry.org, accessed September 15, 2010 Qualify Quantify CUA = | $ QALY and Payers Coventry vs Statins Modified Delfini How do you define value? Me. see www.delfini.org 15% 85% 9 out of 10 8 out of 10 vs. Will it change a person's life? There is no value equation Value is intuitive, reasonable, and cost worthy What is the incremental benefit and cost? Value is complex to evaluate ...the overall impact on resources ...the benefit less the potential harm vs the cost it is not just price--volume matters too! comparative studies evaluate value consistency in lifestyle > QOL for severe conditions improving function is medically necessary Value is spending money on something worth it ...defined as tradeoff between patients wanting treatment and wanting the money overall bang for the buck value is relative and based on alternatives How do you define value? Cancer 1 year 40% @ Standard Care 1.25 year 60% @ New Treatment 1X0.40 1.25X0.60 do the math... = = 0.4 QALY 0.75 QALY $10,000 $3,000 @ @ $10,000-$3,000 | 0.75-0.40 QALY = $20,000 per QALY $50,000 pancreatic Depends on your perspective. Tier 1
Simvastatin Tier 2
Rosuvastatin Tier 3
Fluvastatin Method 1. Choose
8. Rinse & Repeat ... and sometimes we need to climb higher coventry.formularies.com @ www.cearegistry.org search for each agent
limit search to US studies only with CUA ratio's available Apply limitations! Should any positions be changed? economic, humanistic, clinical here it is! hmm...