Merritt: AHRQ Initiative Represents ‘Emerging Consensus’ That Value-Based Purchasing Can Help Improve Outcome, Lower Costs

(Washington, DC)—Yesterday’s publication of a first-ever Comparative Effectiveness Review by the Agency for Healthcare Research and Quality’s (AHRQ) new Effective Health Care Program is an important step forward in helping consumers, clinicians, and purchasers better evaluate competing therapies and make informed health care decisions, the Pharmaceutical Care Management Association (PCMA) said today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for 200 million Americans.

AHRQ’s Effective Health Care Program released its first report, Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease, yesterday. According to AHRQ’s review, a class of prescription drugs, proton pump inhibitors (PPIs), can be as effective as surgery for management of gastroesophageal reflux disease (GERD). GERD results in an estimated $10 billion annually in direct health care costs. The report reviewed various treatments for GERD, including over-the-counter medicines, PPIs, surgery, and endoscopic procedures. This GERD report is the first of 10 reports to be issued by AHRQ’s Effective Health Care Program.

“PCMA applauds AHRQ for putting forward useful information that consumers, clinicians, and purchasers can all use to evaluate competing therapies and better utilize scarce health care dollars,” said PCMA President Mark Merritt. “AHRQ’s efforts are part of a broader emerging consensus that value-based purchasing will lead to better health outcomes, reduce variations in care, and provide for more effective targeting of health care resources. PBMs have been in the vanguard of incorporating comparative effectiveness and other evidence-based medicine tools into the prescription-drug benefit arena. AHRQ’s new initiative will only help further these goals, both in the commercial marketplace and in the Medicare and Medicaid programs.”

PBMs rely upon panels of independent, clinical experts, called Pharmacy & Therapeutics (P&T) committees, to determine which drugs are most effective for specific needs. P&T committees are largely independent providers and include a variety of specialist physicians, pharmacists, and others with specific clinical knowledge of drugs and pharmacotherapy. These committees serve in an evaluative, educational, and advisory capacity in matters concerning formulary development and management. Primarily, this capacity is served in evaluating drugs for safety and efficacy. Development and maintenance of formularies is an ongoing activity, as they must be continually updated to keep pace with new therapies, recent evidence from clinical research, changes in medical practice, and FDA guidance. When drugs are determined to be therapeutically equivalent, PBM get the drug manufacturers of those respective drugs to compete and offer discounts in exchange for better placement on formularies. According to PricewaterhouseCoopers, PBMs generate discounts averaging 25 percent.

AHRQ’s Effective Health Care Program’s first report, Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease, can be found at:

http://effectivehealthcare.ahrq.gov/synthesize/reports/finalGERD.cfm

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The Pharmaceutical Care Management Association (PCMA) is the national trade association representing America’s pharmacy benefit managers (PBMs). PCMA member companies provide pharmaceutical care management services to more than 200 million Americans.

Contact Information:
Phil Blando
(202) 207-3614