US Payer Assessment of the Utility and Impact of Value Dossiers on Decision Making
Author(s)
Mary Fletcher-Louis, MPH1, Sophie Doran, BSc, PhD1, Samantha Feng, MBA and PhD2, Abigail Silber, MPH3, Nandini Hadker, MS3, Matthew O'Hara, MBA3.
1Trinity Life Sciences, London, United Kingdom, 2Trinity Life Sciences, San Francisco, CA, USA, 3Trinity Life Sciences, Waltham, MA, USA.
1Trinity Life Sciences, London, United Kingdom, 2Trinity Life Sciences, San Francisco, CA, USA, 3Trinity Life Sciences, Waltham, MA, USA.
OBJECTIVES: The AMCP Format 5.0 is the standard for presenting clinical, economic, and humanistic evidence to support formulary reviews, but its impact on decisions remains uncertain. The objective of this research was to understand US payer perspectives on use/impact of AMCP Dossiers.
METHODS: A survey was fielded among U.S. payers involved in pharmacy and therapeutics (P&T) decision making for a managed care organization (MCO), integrated delivery network (IDN) or pharmacy benefit manager (PBM) covering >10 million lives.
RESULTS: The sample included n=20 payers, 40% representing large national MCOs, 40% regional MCOs, 10% from IDNs, and 10% from PBMs (average covered lives ranged from 136M [large national MCO] to 11M [IDNs]). The majority (85%) were pharmacy directors, 15% were medical directors. AMCP dossiers were considered extremely/very/somewhat helpful by 80% [10%, 45%, 25%] of payers. The most helpful evidence for making decisions was from clinically-focused peer-reviewed journals (considered very or extremely helpful by 80%). Payer-generated economic analyses were considered very helpful by 70%, in contrast to manufacturer-developed economic models (considered not at all or not very helpful by 60%). Dossiers were frequently requested for rare diseases, with 85% requesting them "routinely" or "always". The clinical evidence section was the most frequently used content, with 90% relying on it, followed by clinical practice guidelines (75%). 57% of respondents use cost per average treatment duration, and 70% find "number needed to treat" (NNT) valuable. When asked what they would like to see in the next AMCP Format, 6 payers noted a stronger focus on comparative effectiveness.
CONCLUSIONS: This research elucidates how U.S. formulary decision-makers leverage AMCP dossiers in coverage evaluations, and confirms dossiers are a critical part of payer engagement. For life sciences manufacturers, this emphasizes the importance of aligning dossier content with payer priorities to strengthen engagement and support evidence-based coverage.
METHODS: A survey was fielded among U.S. payers involved in pharmacy and therapeutics (P&T) decision making for a managed care organization (MCO), integrated delivery network (IDN) or pharmacy benefit manager (PBM) covering >10 million lives.
RESULTS: The sample included n=20 payers, 40% representing large national MCOs, 40% regional MCOs, 10% from IDNs, and 10% from PBMs (average covered lives ranged from 136M [large national MCO] to 11M [IDNs]). The majority (85%) were pharmacy directors, 15% were medical directors. AMCP dossiers were considered extremely/very/somewhat helpful by 80% [10%, 45%, 25%] of payers. The most helpful evidence for making decisions was from clinically-focused peer-reviewed journals (considered very or extremely helpful by 80%). Payer-generated economic analyses were considered very helpful by 70%, in contrast to manufacturer-developed economic models (considered not at all or not very helpful by 60%). Dossiers were frequently requested for rare diseases, with 85% requesting them "routinely" or "always". The clinical evidence section was the most frequently used content, with 90% relying on it, followed by clinical practice guidelines (75%). 57% of respondents use cost per average treatment duration, and 70% find "number needed to treat" (NNT) valuable. When asked what they would like to see in the next AMCP Format, 6 payers noted a stronger focus on comparative effectiveness.
CONCLUSIONS: This research elucidates how U.S. formulary decision-makers leverage AMCP dossiers in coverage evaluations, and confirms dossiers are a critical part of payer engagement. For life sciences manufacturers, this emphasizes the importance of aligning dossier content with payer priorities to strengthen engagement and support evidence-based coverage.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA343
Topic
Health Technology Assessment
Topic Subcategory
Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas