WellPoint Is First Health Benefits Company to Release CER Guidelines for Use in Evaluating Pharmaceuticals

INDIANAPOLIS, May 19 /PRNewswire-FirstCall/ -- WellPoint, Inc. (NYSE: WLP) is the first health benefits company to announce it has standardized comparative effectiveness research guidelines that it will use when evaluating drugs for purposes of improving health outcomes and providing value for members of its affiliated health plans.

"By placing our guidelines in the public domain, we are providing some guidance to pharmaceutical companies looking to offer meaningful information to health benefits companies that are evaluating pharmaceutical products on behalf of its members," said WellPoint Chief Pharmacy Officer Brian Sweet.

The announcement comes as many organizations that received CER funding through the American Recovery & Reinvestment Act are preparing to design and conduct their own studies. CER may be used by WellPoint to assist in establishing drug formulary position, which determines the copay charged to members of its affiliated health plans and other formulary management initiatives.

"As various groups receiving funding begin to design their studies, they can look to our guidelines as one approach on how their study could be evaluated," Sweet said.

Comparative effectiveness research on drugs allows us to compare specific products to each other in terms of health outcomes. When this information is used by health care providers treating 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 overall and WellPoint customers are saving money on pharmacy and medical costs for each member that uses the preferred bisphosphonates.

"This demonstrates that a good comparative effectiveness research study, along with clinical trial information and other peer-reviewed studies published in medical journals, can provide us the tools we need to help improve health outcomes and reduce costs for members of our affiliated health plans," Sweet said. "The key to building studies producing useful information is to ensure they follow medically credible and consistent guidelines. We consider this work one of many contributions WellPoint is making to health care."

About WellPoint, Inc.

WellPoint is committed to improving the lives and health of the people and communities we serve by simplifying the connection between health, care and value. Our goal is to help shape the impact each health care decision has on individuals, the health care system at-large, and our communities. WellPoint's more than 42,000 associates work every day to help create the best health care value for our customers. Through collaborations with providers and with innovative programs, WellPoint's affiliated health plans reward healthy lifestyles and quality, safe and effective care. As the nation's largest health benefits company, with nearly 34 million members in its affiliated health plans, WellPoint is at the center of the health care system. This position provides us with the relationships and insights needed to help create affordable and actionable solutions that improve health care.

As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at www.wellpoint.com.

SOURCE WellPoint, Inc.