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WellPoint Is First Health Benefits Company to Release CER Guidelines for Use in Evaluating Pharmaceuticals
Date:5/19/2010

ating patients, we can see improved quality of health care, better safety and more affordable health care, Sweet said.

WellPoint was the first health benefits management company to publish its health technology assessment guidelines in 2008. WellPoint places the greatest weight in formulary decisions on well-conducted, randomized clinical trials defined in its health technology assessment guidelines.  

The CER guidelines provide WellPoint with a consistent road map to evaluate CER, which can be used as a complement to those randomized clinical trial studies that evaluate efficacy and not effectiveness.

"Currently, CER evaluation is much like the wild, wild West," Sweet said. "While a few organizations have made some strides, there is little in the way of publicly available, comprehensive evaluation criteria. Substantial literature does exist on observational study techniques and analysis methods. Our job is to judge the proficiency and methodology of the study design and its relevance to our population against these techniques and methods."

WellPoint has tested its new guidelines retroactively on two CER studies – one of which focused on bisphosphonates to treat osteoporosis.  WellPoint used its new CER criteria to determine that the research comparing only two osteoporosis drugs was not useful. As a result, WellPoint conducted its own CER analysis of more than 26,000 members using three different drugs. The WellPoint study determined that one drug was more closely associated with lower compliance, higher fracture rates and higher total cost of care compared with others.

WellPoint then changed its formulary to require a trial of one of the two other drugs before beginning therapy for the Tier 3 drug. The results are that members of WellPoint's affiliated health plans have fewer fractures ov
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SOURCE WellPoint, Inc.
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