OBJECTIVES: To assess payer utilization and perceptions of value assessment frameworks (VAFs) in pharmacy and therapeutics (P&T) committees in the US healthcare system.

METHODS: Decision-makers within managed care organizations and health systems received a web-based survey to complete in late 2018. Respondent insights regarding familiarity, utilization, and perceptions of VAFs were sought for 11 questions about the Institute for Clinical and Economic Review (ICER), Memorial Sloan Kettering Cancer Center (MSKCC) Drug Abacus, Patient Perspective Value Framework (PPVF), Innovation and Value Initiative (IVI), and National Comprehensive Cancer Network Evidence Blocks (NCCN-EB).

RESULTS: 43 active members of a pharmacy & therapeutics committees representing over 300 million lives completed the survey. Payers noted the most important (“extremely/very important”) characteristics of VAFs are: rigorous, unbiased methodology (98%) conducted by neutral 3rd party experts (88%) in a transparent (86%) and timely (86%) manner using appropriate metrics and outcomes. Nearly half of all payers reported finding VAFs somewhat useful (47%) within their organizations. Highest familiarity was reported for ICER and NCCN-EB (74% and 70%, respectively); these were also reported as having the highest utilization by the greatest number of payers over the past 6 months (93% and 84%, respectively). Most frequently, these were referenced to obtain clinical and/or economic information to inform coverage decisions. In contrast, a majority of payers reported being “not very familiar” with the PPVF (58%) and IVI (72%), and only a few payers reporting utilizing PPVF (33%) and IVI (26%) over the past 6 months. Payers who reported no utilization of any VAFs to inform coverage decisions noted insufficient validation of the VAFs (36%) as the primary reason.

CONCLUSIONS: VAFs, particularly ICER and NCCN-EB, are influencing a majority of P&T decision makers. Continued research is needed to understand the impact of evolving VAFs on perceptions and influence in decision making.