Will comparative data lead to coverage denied?

We know that drugmakers are a bit leery of comparative-effectiveness research--at least of the way that research could be put into practice. So, just how might the government use data from head-to-head treatment studies? There are some hints in today's Wall Street Journal.

First, the background: The economic stimulus package includes more than $1 billion in funding for comparative effectiveness studies. Those studies might include pitting an older, off-patent diabetes drug against a newfangled costly one to see whether the new one works better for patients. Or it might compare various biologic cancer treatments. In any case, the data from those studies would then be funneled to doctors and other providers as a way to guide treatment.

Drugmakers fear that the meds on the losing end of those trials might be shunted off Medicare and insurer formularies--especially if cost is part of the comparison. "We don't want [it] to be used to deny access to care," a PhRMA VP told the Journal, echoing the comments of some pharma execs.

But the White House says that denials of coverage won't necessarily follow. Sure, if a drug is shown to be simply ineffective, then coverage might be denied. But that's an extreme case, White House budget director Peter Orszag has said. The government might, however, pay more for the drugs that work best than for those that don't work as well. True to its tech-loving self, the White House also envisions some combo of the comparison data and electronic medical records. "User-friendly pop-up alerts for physicians at the point of care," namely. Sound good?

- read the WSJ Health Blog item
- check out the story in the WSJ

Suggested Articles

It’s final: England won’t be covering AZ’s quick-selling Tagrisso in previously untreated non-small cell lung cancer patients with EGFR mutatations.

Top J&J meds have managed to hang onto market share in the face of new generics and biosims, but the drugmaker expects the pain to continue in 2020.

Lonza’s search for a new CEO is expected to be wrapped up this year as the CDMO homes in on a list of veterans from outside the company.