Practical Research that Identifies and Illuminates

[R3] Patient-Reported Outcomes and Patient Preferences: Considerations for Coverage Policy Decisions?

ACPE UAN: 0233-0000-19-033-L04-P | Contact Hours: 1.25 | Activity Type: Knowledge-based

Faculty(s)

• 

  Kim A. Caldwell, RPh

  Principal
  Texas Star Healthcare Consulting, LLC
  McKinney, Texas
• 

  James D. Chambers, PhD, MPharm, MSc

  Associate Professor, Institute for Clinical Research and Health Policy Studies
  Tufts Medical Center
  Boston, Massachusetts
• 

  Jennifer S. Graff, PharmD

  Vice President, Comparative Effectiveness Research
  National Pharmaceutical Council
  Washington, District of Columbia
• 

  Eleanor M. Perfetto, PhD

  Executive Vice President, Strategic Initiatives
  National Health Council
  Washington, District of Columbia

Moderator(s)

• 

  Jennifer S. Graff, PharmD

  Vice President, Comparative Effectiveness Research
  National Pharmaceutical Council
  Washington, District of Columbia

Globally, health plans and payers are expanding their efforts to solicit patient and public input when allocating health resources. However, despite the increased availability of patient-reported outcomes and consumer cost-sharing data, it is unclear how patient or health plan member input is considered by health plans when making coverage decisions. Concerns exist that patient-input may disrupt the contractual requirements for health plans to provide “medically necessary” care and treatments. Additionally, allocation of resources may be inefficient if the treatments reimbursed for care are not valued by the patients who will ultimately use the services.

This session and panel discussion will focus on the following key questions: What types of input should be considered (e.g., consultation, deliberation, etc.)? When should input be solicited (e.g., before, during or after the coverage decision)? What input should be considered (e.g., published patient-reported outcomes, lay-patients, member surveys, etc.)? Whose input matters (e.g., members, patient group, etc.)? What are the barriers and opportunities?

Learning Objectives:

At the completion of this activity, participants should be able to:

1. Describe how health plans currently consider patient input (e.g., member input, patient preference, and patient-reported outcomes) when developing specialty drug coverage policies.
2. Contrast procedures to solicit and incorporate patient input with procedures to solicit and incorporate provider input in coverage policies.
3. Deliberate the importance of patient input in coverage development.
4. Summarize the challenges and opportunities associated with incorporating patient input and patient-reported outcomes in coverage policies.