Stephen J. Ubl is president and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA)
The ongoing debate over the cost and affordability of new medicines – and health care more broadly – is an important one. No patient should have to worry about whether they can afford the care they need. At the same time, the discussion often fails to move beyond the question of short-term costs to the more important issue of whether we are delivering better value for patients. To get to real solutions for America’s patients, we need a system-wide focus on delivering value.
America’s biopharmaceutical research companies are committed to delivering medicines that add value for patients and support a competitive health care system that demands and supports medicines that add value. Ongoing research on the value of medicines, as well as the more recent emergence of new “value assessment” tools, are areas where we see opportunity for greater progress toward better value, if those tools are well-designed and appropriately used.
We recognize the challenge of getting to better value in health care is extraordinarily complex, which is why it is so important to work together to make sure it is done right. First and foremost, this means making sure value assessments are focused on the patient and account for patient differences. Second, value assessment tools must be reliable, based on scientific evidence and support progress in developing new treatments for patients with unmet medical needs. Last, it means making sure these tools are used in ways that help physicians and patients decide which treatment options are best for the individual patient and not in ways that replace personal treatment decisions with a one-size-fits all judgment of value.
While some emerging value assessment tools hold promise, we are concerned others fall short of these goals. Stronger standards and more open processes are needed to ensure all value assessment tools support better value and patient centeredness across the health care system. One framework developed by the Institute for Clinical and Economic Review (ICER) is particularly concerning because of flaws in its methodology, lack of inclusion of patient perspectives and vulnerability for misuse in ways that come between the health care provider and patient in deciding which care options are best (or most valuable) for an individual patient.
ICER illustrates how value assessment, if not carefully constructed, will fail to account for individual differences among patients and fail to recognize how the role and value of new medicines evolve significantly over time. Use of this type of tool in policy decisions could replace individual physician and patient needs with one-size-fits-all value judgments and would undermine the real progress we’ve made toward patient-centered comparative effectiveness research.
The importance of focusing on patient needs was underscored by the American Society for Clinical Oncology (ASCO), which said “it is crucial that discussions with patients include an assessment of which treatments are most likely to support their needs, goals, and preferences, and that information that could affect their treatment decision making be provided as transparently as possible.”
We can do better, but we need to work together. This has been made clear by leaders across the cancer field who have called for better approaches to value assessment that are “responsive to two basic dynamics: the variability of value among individuals and stakeholders, and the variability of value over time” – acute needs for the 14.5 million cancer survivors living in the United States and their health care providers.
PhRMA is committed to advancing scientifically sound, patient-focused value assessment tools that meet these objectives.