CEVR

Variation in US Commercial Health Plan Coverage Restrictions for Cell and Gene Therapies This Viewpoint examines variations in US commercial health plan coverage restrictions for cell and gene therapies.

US commercial payers vary in how they cover cell and gene therapies, according to a new study of 541 coverage policies by Tufts-CEVR’s SPEC team. 52% of policies had restrictions beyond FDA label, often limiting access to patient subgroups or requiring step therapy.

Read at: tinyurl.com/5dwhv726

CEAs often undervalue vaccines by excluding family spillover effects. New research from CEVR and Merck explores the impact of omissions.

Half of studied CEAs omitted spillover effects. Including them improved cost-eff. by avg. of ~20%; 10% of results became cost-saving.

Read: tinyurl.com/y8p6jtwm

Characterizing financial risk from out‐of‐pocket expenditures across dementia stages INTRODUCTION Older adults with dementia incur considerable out-of-pocket (OOP) health care expenses, but it is unclear how their financial burden differs by dementia stage. METHODS We identified 2...

Older adults with dementia face substantial OOP costs. New CEVR research explores financial risks to patients/families: 21% of individuals w/ severe dementia face catastrophic costs; 12% fall below poverty threshold due to costs.

Read at: tinyurl.com/3pfbt7fp

@pattysynnott.bsky.social

Join CEVR on Sept. 30 from 2-3 pm ET for a health policy seminar from Carl Asche, PhD, MSc. Dr. Asche will discuss new research to standardize definitions and outcomes reporting for patient-facing digital health interventions (PICOTS-ComTeC and CHEERS-DHI)

More at: tinyurl.com/ywn7abjp

Join CEVR on Sept. 30 from 2-3 pm ET for a health policy seminar from Carl Asche, PhD, MSc. Dr. Asche will discuss his work to define patient-facing digital health interventions and standardize reporting practices (PICOTS-ComTeC and CHEERS-DHI)

More at: tinyurl.com/ywn7abjp

How can we make #valueassessment more patient-centric? New consensus recs from CEVR’s Tara Lavelle & colleagues include:

• Engage patients throughout
• Count all costs to patients & caregivers
• Share results in plain language

Read all 28 recommendations here: tinyurl.com/m9wxf6wj

Health Technology Assessment, Again: A Transparent, Evidence-Based Approach For CMS Drug Price Negotiations | Health Affairs Journal The Centers for Medicare and Medicaid Services (CMS) can now negotiate the prices of a set of drugs that represent significant Medicare expenditures. The long-term success of negotiations will depend ...

New in Health Affairs: CMS should adopt a formal #HTA approach for #IRA drug price negotiations.

Benefits: transparency, broader evidence, more patients/stakeholder input, more acceptance of negotiations, etc.

More from @dano-hta.bsky.social et al: tinyurl.com/2s36yjta

@commonwealthfund.org

What drug characteristics explain the wide range of manufacturer rebates? AbstractIntroduction. Prescription drug list prices, often cited in policy discussions, do not account for rebates negotiated between manufacturers and pay

What explains the wide range of specialty drug rebates? New research from @mollytoba.bsky.social et al finds cancer/orphan drugs have the lowest rebates, and biosimilars/originators the highest.

Read more in Health Affairs Scholar at: tinyurl.com/y4rc468d

@argenx.com #PBM #Rebates #DrugPrices

CEVR is thrilled to welcome David Strutton, PhD, as a Senior Fellow! Dr. Strutton brings 30+ years of global leadership in health policy, biopharma, and HTA. His expertise in real-world evidence and access strategy will be a tremendous asset.

Read more at: tinyurl.com/3bz9te3p

Meet Hao-Hsin (Taylor) Huang, MS, today’s featured #CEARegistry Summer Fellow. Taylor is pursuing her PhD in Pharmacy Systems, Outcomes, and Policy at the University of Illinois, Chicago.

Our thanks to the @moorefound.bsky.social for funding the CEA Registry Fellowship program!

VUMC researchers host international fellows for economic evaluation, decision science training Vanderbilt recently hosted 11 international fellows to provide training to help them address public health issues in their home countries.

Great application of our CEA Registry at the #Vanderbilt Center for Health Economic Modeling: 11 international fellows from #LMICs used the Registry to conduct CEAs of public health interventions.

Read more at: tinyurl.com/88varaue

@peterneumann11.bsky.social #ISPOR

Value assessment for health services and procedures: a call to action in a new political climate

New in JCER: CEVR’s Meng Li and @peterneumann11.bsky.social call for more value assessment of health services/procedures. These interventions are ~70% of health care spending but are often implemented without robust evidence and, unlike drugs, can cost more over time.

Read: tinyurl.com/ycxrppby

CEVR Summer Fellow Spotlight: we’re thrilled to have Rosemond Amamoo, MD, MPH as a #CEARegistry Summer Fellow! Rosemond is pursuing her PhD in Health and Pharmaceutical Outcomes at @uarizona.bsky.social.

Our thanks to the @moorefound.bsky.social for funding the CEA Registry Fellowship program!

Health Economics and Outcomes Research (HEOR) Certificate Program - Tufts CTSI Overview The Tufts University Graduate School of Biomedical Sciences (GSBS) Clinical and Translational Science (CTS) Graduate Program is delighted to offer an accredited Certificate Program in Health ...

Two weeks left to apply: Earn your #HEOR Certificate online from @tufts.edu with globally-recognized faculty like @peterneumann11.bsky.social, @dano-hta.bsky.social, James Chambers, and more from CEVR. Apply today!

Deadline is Aug. 1.

tinyurl.com/pr6drkhf

#RWE #pharma

Today’s #CEARegistry Summer Fellow is Pooja Gokhale, PharmD. Pooja is pursuing her PhD in Pharmaceutical Health Services, Outcomes, and Policy at @universityofga.bsky.social.

Our thanks to @moorefound.bsky.social for funding the CEA Registry Fellowship program!‬‬

Larry Mose, MSc is today’s #CEARegistry Summer fellow. Larry earned his MSc from @york.ac.uk and hopes to work in the field of #HEOR.

Our thanks to the @moorefound.bsky.social ‬for funding the CEA Registry Fellowship program!‬‬

4/ Authors: James Chambers, @mollytoba.bsky.social‬, Julia Rucker, Katherine Clifford, Jon Campbell, and James Motyka.

Drug Coverage Policies And Clinical Guidelines Alignment: Most Coverage Decisions Include Additional Restrictions | Health Affairs Journal Utilization management criteria influence patients’ access to specialty drugs, yet the processes used by health plans to establish these criteria are not well understood. This study examined the alignment between clinical practice guidelines and plans’ utilization management criteria. Using the Tufts Medicine Specialty Drug Evidence and Coverage Database (December 2023), we reviewed US-based guidelines for 389 drug-indication pairs, excluding oncology and biosimilar treatments. We categorized guidelines as recommending or not recommending utilization management, based on alignment with each drug’s Food and Drug Administration label—specifically, line of therapy and clinical requirements (for example, disease severity). We analyzed 5,699 coverage policies from eighteen large commercial health plans. When guidelines recommended utilization management, 67 percent of plans’ coverage decisions aligned with the recommendation; when guidelines did not recommend utilization management, only 37 percent of decisions were consistent. Most plans imposed utilization management criteria (61 percent of all decisions), and plans were more likely to be consistent with guideline recommendations when utilization management was recommended, indicating a weak alignment with guideline recommendations.

3/ In other words, 63% of plan decisions included UM when guidelines did not support UM. Our findings raise concerns around how UM policies are developed and how the misalignment between UM policies and guidelines impacts patient access to medicines.

Read at: tinyurl.com/5d7svsbf

2/ Overall, alignment with guidelines is often weak. Most plans (61%) imposed UM criteria, irrespective of clinical guideline availability. Health plans were more likely to align with guidelines that recommended UM versus those that do not (67% vs. 37%).

1/ How closely do health plans’ drug #utilizationmanagement (UM) policies align with #clinicalguidelines? CEVR and NPC examined policies for 389 drug-indication pairs from 18 commercial insurers. Here’s a thread on what we found:

Strategic evidence planning in the IRA: Insights from Year 1 drug price negotiations | Becaris Publishing

Strategic evidence planning in the IRA: Insights from Year 1 drug price negotiations | becarispublishing.com/digital-cont...

Frontiers | Value attribution for oncology combination regimens: going beyond frameworks to balance innovation, access, and affordability Combination therapies are a mainstay in cancer treatment, but reimbursement access can be limited, owing to complexities around value assessment and pricing,...

Traditional #valueassessment lacks methods to evaluate #oncology combination txs, posing challenges for drugmakers, HTA bodies, and payers.

In a new commentary in Frontiers in Pharmacology, CEVR’s Dan Ollendorf et al explore available frameworks and chart a path forward: tinyurl.com/kh84ueb4

Meet Fengdi Zhang, MPH, today's featured #CEARegistry Summer Fellow. Fengdi is pursuing her PhD in Pharmaceutical Health Services Research at @univofmaryland.bsky.social

Our thanks to the @moorefound.bsky.social for funding the CEA Registry Fellowship program!

Health utilities in Alzheimer's disease: A survey of patients and caregivers in the United States - Pei-Jung Lin, Abigail G Riley, Patricia G Synnott, Terry L Frangiosa, Amber Roniger, Peter J Neumann... Background The introduction of new Alzheimer's disease (AD) treatments necessitates updated health utilities for economic evaluations. Objective Measure h...

There are new drugs for #Alzheimer’s but utility data for AD patients and caregivers are limited/outdated. A new survey from CEVR’s Lin et al and UsAgainstAlzheimer's provides fresh data, stratifies utilities by care setting, etc.

Read in J Alzheimer’s Dis: tinyurl.com/mu5rt9yd

#HEOR

Meet Hanxuan (Astrid) Yu, MEd, today’s #CEARegistry summer fellow. Astrid is working toward her PhD at @hsph.harvard.edu

Our thanks to @moorefound.bsky.social for funding the CEA Registry Fellowship program!‬

@peterneumann11.bsky.social @pattysynnott.bsky.social

CEVR is thrilled to introduce the 2025 cohort of the Tufts-CEVR CEA Registry Summer Fellowship Program, which is supported by the @moorefound.bsky.social. Stay tuned over the next two months for featured posts about each fellow!

More details at: cevr.tuftsmedicalcenter.org/news/2025-ce...

Join our team! CEVR is #hiring a research project coordinator: cevr.tuftsmedicalcenter.org/news/researc...

Join CEVR on June 17 from 2-3 ET for a health policy seminar from Nathaniel Hendrix, PhD, PharmD. Dr. Hendrix will discuss trends in and effects of pharmaceutical industry payments to primary care physicians.

More details at: tinyurl.com/3e2nesrc

New in Value in Health: three former CEA Registry Summer Fellows (Xujun Gu, Hanwen Zhang, and Divya Patil) and U of Maryland's Julia Slejko used the CEA Registry to explore the utility of AI-assisted data extraction.

Read at tinyurl.com/37mh5n6m