OBJECTIVES: This study aimed to evaluate payer perceptions around current and future utilization of value assessment frameworks (VAFs) and their impact on chimeric antigen receptor T-cell (CAR-T) therapies.

METHODS: In December 2017, U.S. pharmacy and medical directors from managed care organizations completed a web-based survey to assess their familiarity with oncology VAFs and their use in cancer and specifically CAR-T therapies formulary reviews. VAFs assessed included ASCO, ESMO-MCB, ICER, MSKCC DrugAbacus, NCCN Evidence Blocks, and Avalere/FasterCures PPVF.

RESULTS: Of the 59 respondents, were very familiar with NCCN Evidence Blocks (58%) and ICER (54%) while only a minority (24%) were very familiar with ASCO. The most commonly referenced VAFs for cancer and CAR-T therapies, respectively were NCCN Evidence Blocks (53%; 37%), ICER (37%, 14%), and ASCO (29%, 17%). Thirty five (59%) respondents reported reviewing coverage of CAR-T therapies since June 1, 2017 and 4 (7%) anticipated reviewing before June 1, 2018. Among the 35 reviewers of CAR-T therapies, NCCN Evidence Blocks (37%) was the most commonly referenced VAF. Payers reported VAFs were “nice to know” in oncology but were not factored into CAR-T therapy coverage decisions. Leading payer reasons for not using VAFs in CAR-T therapy coverage decisions included lack of added value, no/minimal experience with VAFs, and validity concerns. Respondents indicated that the preferred type of information to increase the usefulness of VAFs in informing future coverage decisions around CAR-T therapies were clinical trial data (84%), treatment recommendations/guidelines (77%), and available alternative therapies (67%).

CONCLUSIONS: Payers are cautious on their use of VAFs. While VAFs can provide useful background information, they have not been substantially factored into coverage decisions in oncology. With the growing focus on value-driven decision making, there may be an opportunity to advance VAFs and facilitate timely assessment and access to CAR-T therapies.