National Pharmaceutical Council to CVS: Join Us in a Broader Dialogue to Address Health Care Spending

The viewpoints published today on the Health Affairs Blog bring an important question to mind: will CVS join the National Pharmaceutical Council (NPC) and key stakeholders from across the health sector in our ongoing and constructive dialogue about health care spending and value? We invite CVS to be part of a broader conversation that checks the finger-pointing at the door and utilizes evidence and research as the basis for solutions.   

This is a dialogue that has been long underway. For a number of years now, NPC—a health policy research organization that does not engage in advocacy—has examined topics such as value assessment frameworks and health care spending through the lens of evidence, methods, and science.

In the area of value assessment, we regularly engage in constructive conversations with framework developers like the Institute for Clinical and Economic Review (ICER), bring multiple views to the table, and consider the impacts on the entire health care system, and in particular patients, who are at the center of this system. It is in this spirit, and as part of our longstanding work in this area, that we questioned CVS’s recent announcement of its use of the ICER value assessment framework. CVS’s description of how it would strictly apply a singular cost effectiveness threshold when reviewing a new treatment—a less flexible approach than even ICER uses—understandably raised a number of concerns throughout the health care community. Ideally, through our published dialogues, all of us can better understand the approach that CVS and other organizations are taking in considering the value of new and innovative treatments.   

In the United States, value assessment is still evolving, and frameworks vary greatly in their approaches and intended end users. That’s why NPC developed guiding practices for patient-centered value assessment: the practices provide a range of evidence-based considerations, to help ensure assessments are effective tools to support value in patient care and outcomes, rather than blunt tools that ignore patient concerns and impede access to care. 

The interest in value assessment is increasing because there is a concern about the growth in health care spending, which is an incredibly important issue. But we cannot pin increases in health care spending on one sector alone. To get at the root of this challenge, all health care sectors—biopharmaceuticals, PBMs and insurers, hospitals, devices—need to consider our roles in addressing health care spending. We need to come together in a constructive dialogue and ask ourselves some difficult questions.

At NPC, we aren’t sitting idly by. In February, we launched Going Below the Surface, an effort to broaden and improve the conversation around how we use health care resources in the United States. The initiative is aimed at better understanding the roots of the nation’s health investments by promoting a discussion that is firmly based in health policy and systems research. Already, key organizations representing payers, providers, researchers, hospitals, patients and others have joined in this effort. NPC, and the Going Below the Surface initiative, will not, as CVS implies, engage in finger-pointing at any one sector. 

We are not alone in these efforts to find constructive, research and evidence-based solutions to health care spending—we’re encouraged that many other organizations are forming groups and beginning to have dialogues. In addition to Going Below the Surface, we have joined with Anthem in supporting leading health policy journal Health Affairs in the development of a high-level Health Care Spending and Value Council led by former U.S. Senate Majority Leader Dr. Bill Frist and former Food and Drug Administration Commissioner Dr. Margaret Hamburg.

We invite CVS to join us in “going below the surface” and being a part of this constructive process. We welcome their participation with us and other stakeholders in this important dialogue to address spending—across our entire health care system—and help us in developing real solutions. We’re serious about the invitation, and we hope the answer will be “yes.”

Read the posts on the Health Affairs Blog:

• "CVS To Restrict Patient Access Using Cost Effectiveness: Too Much, Too Soon" by NPC's Dr. Robert W. Dubois
• "Drug Prices: Time for Action" by CVS's Dr. Troyen Brennan and Dr. Surya Singh