OBJECTIVES: Research conducted in 2017 found that HTA processes provide European payers stronger negotiating power for oncology medicines than their US counterparts. Oncology drug management in the US was limited, and tools modeled to use value as a criterion for drug management were not widely implemented. Increased competition in certain oncology indications since 2017 led to the question of whether US payer management has evolved. This research assesses whether US management tools are approaching HTA-like assessment tools.

METHODS: We began by reviewing literature on FDA approvals, NCCN guidelines, and formulary access. Next, we developed and sent an online survey to 21 payers, with the sample and survey designed to match those from the 2017 research. Payers were asked about management tools being employed, challenges to management, and management within specific indications. We then reviewed HTA assessments and followed up with in-depth telephone interviews, as necessary, with payers in France, Germany, and the UK and compared findings across markets.

RESULTS: Management of oncology drugs in the US remains limited. US payers continue to utilize traditional management tools which are ineffective at controlling cost. HTA-like assessment tools including pathways of care, value frameworks, and risk-based models have still not been widely adopted, although some integrated delivery networks have implemented these tools. In contrast, European payers can limit reimbursement, even when there are no therapeutic alternatives available. While European payers have recommended some oncology medicines, other treatments have been given non-favorable HTA decisions.

CONCLUSIONS: Barriers remain for US payers to move toward a more HTA-like assessment of oncology medicines, and these tools are still not widely adopted. Larger systemic changes may be required before the US can move towards a model that looks more like other markets – where cost, value, and clinical effectiveness are considered – when determining coverage for oncology medicines.