Category: Professional Posters
Purpose: As increasing numbers of high cost oncology and specialty drugs are approved, many with marginal clinical benefit, the traditional approach to formulary management is no longer sustainable. Value is a key consideration in discussions about reducing costs in healthcare. The U.S. lacks a national program that provides comprehensive review of high cost medications. While leading organizations in the U.S. have released value frameworks, there is limited evidence showing their utility in decision-making. The purpose of this study was to pilot an evidence-based comprehensive value assessment at an academic medical center to look beyond the traditional approach to formulary management.
Methods: In January 2018, the Formulary Value Analysis Committee was established with multidisciplinary clinical representation across Yale New Haven Health System. A checklist was developed to allow for systematic identification of target drugs for value assessment. This process was designed to empower pharmacists to engage in the value assessment process. Further, we developed a step-by-step process for evaluation of a drug, and a standardized method of presentation called the Value Assessment Framework. We describe the steps taken to create the Formulary Value Analysis Committee, a structure that supports pharmacoeconomic inclusion in formulary decision making, and we illustrate the creation of the value assessment framework. A pilot drug was identified by the checklist and tested through the value assessment framework.
Results: The results of the comprehensive value assessment process, along with the results of the pilot drug assessment were presented to the Formulary Value Analysis Committee for validation and feedback. A scorecard was developed to objectively summarize efficacy, safety, and level of evidence for the compared drugs and represent overall value of the drugs. The updated Value Assessment Framework is intended to be utilized by the Formulary Value Analysis Committee to make a formal recommendation to the appropriate pharmacy and therapeutics committees at Yale New Haven Health System. Practical requirements for developing a useful VAF involve ensuring the appropriate data is available and results are presented in a meaningful way.
Conclusion: Successful implementation of the Value Assessment Framework requires education and incremental culture change. Successful program development requires involvement of clinical champions in determining the guiding principles of the program. Moving toward a pricing system that matches the value of a drug will be challenging. We share these experiences to encourage a national conversation about the rising costs of health care. Future directions include continued iterations of the Value Assessment Framework, education around the benefit of the pharmacoeconomic perspective, and stakeholder buy-in for the new formulary management model.