WellPoint, long a leader in developing a transparent drug coverage evaluation process, is creating drug assessment criteria that will include guidance on how to handle comparative effectiveness research findings.

"Sometime this year we should have additional technology assessment criteria developed and be a little bit more explicit in a few areas that we think need to be fleshed out a little more," Brian Sweet, chief pharmacy officer for WellPoint, said in an interview. The company last published assessment criteria in October 2008, emphasizing patient outcomes in its data requirements (Also see "WellPoint Seeks More Quality Of Life, Cost Data In Formulary Submissions" - Pink Sheet, 27 October, 2008.).

The updated criteria "will be more focused on some of the comparative effectiveness information that we're looking for, which ... we haven't been as explicit about documenting just because we've been ... working with it for only a few years."

The concept of comparative effectiveness research gained a boost in the new health care reform law, which creates an independent institute with joint private and federal funding to guide and oversee CER (Also see "Senate Considers Revised Comparative Effectiveness Plan In Reform Bill" - Pink Sheet, 7 December, 2009.).

WellPoint's new guidelines, Sweet said, "will focus on nonrandomized trials, so things like what the [independent CER] agency would be producing. What type of information do we want to see and how are we going to grade it when it is developed? How are we going to evaluate it? You have to have a system and a process. That's what we're going to be publishing."

WellPoint already conducts comparative research on patient outcomes with drugs through its HealthCore subsidiary. It has created an integrated research network which involves practicing physicians in markets where it has health plan membership and is focused on collecting clinical data at the point of care, providing "observational-style, real-life" information, Sweet said.

For example, WellPoint's current formulary reflects outcomes studies it conducted with HealthCore in 2009 on drugs for osteoporosis, chronic obstructive pulmonary disease, asthma and migraine. Its plans lifted prior authorization requirements on oral asthma drugs as the result of one study (Also see "WellPoint CE Study Results In Coverage Adjustment For Oral Asthma Drugs" - Pink Sheet, 31 August, 2009.).

In general, Sweet said the new criteria WellPoint will publish will be "no different than what we're actually doing. It's just kind of being more formal about what it is we're actually doing ... how we're doing it, what type of information, and just being transparent."

The company even sees the opportunity for its internal research to contribute to the efforts of the new CER institute. "I think the integrated research network I described ... clearly can be an engine that could be used by the agency doing comparative research, because we can bring more data and more capabilities and resources to the table."

Sweet believes drug manufacturers already are focusing more on understanding the value of their drugs through this kind of research. "You're going to see a lot more investment on their part over the next several years focused on comparative effectiveness research, outcomes information, health economic and total cost of care information," Sweet said. "We view this as really something that we need to be collaborative with them on."

- Scott Steinke (s.steinke@elsevier.com)

WellPoint Will Put Comparative Effectiveness Guidance In Updated Drug Assessment Criteria

More from Archive

More from Pink Sheet