Recent policy initiatives highlight payers' attempt to apply cost-effectiveness data to support and accept coverage, guide payment policy and evaluate alternative therapies and interventions. This session will address, among other hot topics: -provisions within MMA that requires AHRQ to conduct research on "outcomes, comparative clinical effectiveness, and appropriateness of healthcare, including prescription drugs"; Drug Effectiveness Review Project (DERP), an alliance of Medicaid programs and nonprofit organizations, to synthesize and judge clinical evidence for drug class reviews; CMS' Coverage with Evidence Development (CED) guidance to encourage the collection of clinical data about patients' treatment options by linking coverage decisions with data collection requirements.



Objectives:

Identify current approaches used by Medicare, Medicare Part D and Medicaid settings to evaluate cost-effectiveness.

Evaluate what these efforts mean to current and pipeline drug and device payment and coverage decisions, including at the local level.

Learn how to prepare a product for reimbursement or coverage under the challenges put forward as a result of application of cost-effectiveness.