User login
The goal of comparative effectiveness research should be to find the best products to meet a clinical situation instead of a tool to be used by payers to make cost-based coverage decisions, the American College of Rheumatology recently said.
The ACR’s Committee on Rheumatologic Care recently updated its position statement on CER, noting that high-quality comparative effectiveness research and cost-effectiveness analysis “can and should inform individual provider and patient decisions about the relative value of diagnostic and therapeutic options.”
One concern that Dr. Fahey noted, specific to the rheumatology space, is that there currently are few CER data to draw upon, which as a result, makes it harder to have meaningful conversations about clinical value.
“Quite frankly right now, a lot of times those decisions are already heavily influenced by the payer’s formulary structure and what is on their preferred tier and what is on their second, third, or fourth tier,” he said. “We just don’t have enough comparative effectiveness data yet to be a huge influence. The formulary and step edits for each individual payer are still based extremely heavily on their cost and rebates. This is why, circling back to the whole question to begin with ... when we updated the position statement, we sort of reinforced our concern that this should be made to guide clinical decisions and not payer-type coverage decisions.”
He noted that the ACR does have registries that are building real-world data about the various products, but there is still a ways to go to have an effective database that would be usable for quality CER information.
“We are hopeful that, over time, especially with things like registries, the ACR has a registry that compiles real-world data from our members about our patients, that we will be able to come up with a more real-world comparison between different medications,” Dr. Fahey said. “The concern is that the payers will use the results of comparative effectiveness research to make very black-and-white decisions about their formulary and about treatment options and things like that.”
The position statement says that the ACR is doing its part to help collect information. In 2014, it launched the Rheumatology Informatics System for Effectiveness (RISE), which “allows rheumatologists throughout the country to seamlessly and effortlessly transfer anonymous patient outcome data to a national registry.” According to the position statement, “thus far, RISE has collected more than one million patient encounters, positioning RISE to become the premier source for real-world CER data in rheumatology.”
“It would be fantastic if we already had the data about which medication provided the best value,” Dr. Fahey said. “Our drugs are extremely expensive, at least our biologic drugs, and we understand that the goal is to provide both good quality care but cost efficient care.”
The goal of comparative effectiveness research should be to find the best products to meet a clinical situation instead of a tool to be used by payers to make cost-based coverage decisions, the American College of Rheumatology recently said.
The ACR’s Committee on Rheumatologic Care recently updated its position statement on CER, noting that high-quality comparative effectiveness research and cost-effectiveness analysis “can and should inform individual provider and patient decisions about the relative value of diagnostic and therapeutic options.”
One concern that Dr. Fahey noted, specific to the rheumatology space, is that there currently are few CER data to draw upon, which as a result, makes it harder to have meaningful conversations about clinical value.
“Quite frankly right now, a lot of times those decisions are already heavily influenced by the payer’s formulary structure and what is on their preferred tier and what is on their second, third, or fourth tier,” he said. “We just don’t have enough comparative effectiveness data yet to be a huge influence. The formulary and step edits for each individual payer are still based extremely heavily on their cost and rebates. This is why, circling back to the whole question to begin with ... when we updated the position statement, we sort of reinforced our concern that this should be made to guide clinical decisions and not payer-type coverage decisions.”
He noted that the ACR does have registries that are building real-world data about the various products, but there is still a ways to go to have an effective database that would be usable for quality CER information.
“We are hopeful that, over time, especially with things like registries, the ACR has a registry that compiles real-world data from our members about our patients, that we will be able to come up with a more real-world comparison between different medications,” Dr. Fahey said. “The concern is that the payers will use the results of comparative effectiveness research to make very black-and-white decisions about their formulary and about treatment options and things like that.”
The position statement says that the ACR is doing its part to help collect information. In 2014, it launched the Rheumatology Informatics System for Effectiveness (RISE), which “allows rheumatologists throughout the country to seamlessly and effortlessly transfer anonymous patient outcome data to a national registry.” According to the position statement, “thus far, RISE has collected more than one million patient encounters, positioning RISE to become the premier source for real-world CER data in rheumatology.”
“It would be fantastic if we already had the data about which medication provided the best value,” Dr. Fahey said. “Our drugs are extremely expensive, at least our biologic drugs, and we understand that the goal is to provide both good quality care but cost efficient care.”
The goal of comparative effectiveness research should be to find the best products to meet a clinical situation instead of a tool to be used by payers to make cost-based coverage decisions, the American College of Rheumatology recently said.
The ACR’s Committee on Rheumatologic Care recently updated its position statement on CER, noting that high-quality comparative effectiveness research and cost-effectiveness analysis “can and should inform individual provider and patient decisions about the relative value of diagnostic and therapeutic options.”
One concern that Dr. Fahey noted, specific to the rheumatology space, is that there currently are few CER data to draw upon, which as a result, makes it harder to have meaningful conversations about clinical value.
“Quite frankly right now, a lot of times those decisions are already heavily influenced by the payer’s formulary structure and what is on their preferred tier and what is on their second, third, or fourth tier,” he said. “We just don’t have enough comparative effectiveness data yet to be a huge influence. The formulary and step edits for each individual payer are still based extremely heavily on their cost and rebates. This is why, circling back to the whole question to begin with ... when we updated the position statement, we sort of reinforced our concern that this should be made to guide clinical decisions and not payer-type coverage decisions.”
He noted that the ACR does have registries that are building real-world data about the various products, but there is still a ways to go to have an effective database that would be usable for quality CER information.
“We are hopeful that, over time, especially with things like registries, the ACR has a registry that compiles real-world data from our members about our patients, that we will be able to come up with a more real-world comparison between different medications,” Dr. Fahey said. “The concern is that the payers will use the results of comparative effectiveness research to make very black-and-white decisions about their formulary and about treatment options and things like that.”
The position statement says that the ACR is doing its part to help collect information. In 2014, it launched the Rheumatology Informatics System for Effectiveness (RISE), which “allows rheumatologists throughout the country to seamlessly and effortlessly transfer anonymous patient outcome data to a national registry.” According to the position statement, “thus far, RISE has collected more than one million patient encounters, positioning RISE to become the premier source for real-world CER data in rheumatology.”
“It would be fantastic if we already had the data about which medication provided the best value,” Dr. Fahey said. “Our drugs are extremely expensive, at least our biologic drugs, and we understand that the goal is to provide both good quality care but cost efficient care.”