Understanding payer challenges in Multiple Sclerosis, Epilepsy, Migraine and Neurodegenerative disease
Despite wide unmet need across a number of neurological conditions, no really high impact breakthrough therapies have come to the market in recent years. The price for generics has continued to rise—sometimes dramatically—and the broad upward trend in new drug pricing shows no sign of abating. Payers want effective therapies and evidence of utility, and many question the value of new drugs that offer only marginal clinical benefits. What are cost-conscious payers doing to manage the escalating cost of neurological disease treatments?
To examine approaches to pricing and reimbursement (P&R) in multiple sclerosis, epilepsy, migraine, Alzheimer's disease and Parkinson's disease, we interviewed leading US and European payers. In Pricing and Reimbursement in Neurology: Payer Views they examine how price trends are affecting patient access, the impact of COVID-19, and they reveal the strategies they employ for formulary placement, tiering, reimbursement and pricing.
Payers explore each condition:
Multiple sclerosis
Epilepsy
Migraine
Alzheimer's disease
Parkinson's disease
What industry experts say...
"We've seen some patients switch over to Ocrevus. However, we're beginning to see more than its fair share of additional business, which makes us wonder, as a plan, if doctors are switching over to Ocrevus because they can get the revenue for those infusions. We have other drugs out there that are discounted. Even though the list price may be 20 percent more, they are rebated, which makes the price actually less, and the patient can take them themselves. And so we've talked at our P&T meeting about looking at this class and specifically if we have to pull in the reins a little bit on Ocrevus, because we're seeing some patients being moved around. Rheumatologists and neurologists have infusion centres as part of their practice, and I think that bringing patients back into the office for infusions is probably a bigger driver than the lower net price."
US Payer 4
"We have had three anti-epileptic drugs since 2011. None of these drugs got an added benefit which was a wrong decision by the G-BA. For a specialist paediatrician to treat epilepsy, they need some drugs to change, maybe even if it's officially a direct comparison, it's not superior. Nevertheless, for a single patient, it may be okay if one doctor were committing to another drug that is similar, but a little bit different. So you may have a chance to treat these patients. In my view, the big problem for our system is that these anti-epileptic drugs are not available in most cases, because epilepsy may be hard to treat and we may have to do a lot to control that. In my view the G-BA must accept newer drugs and mustn't say 'no improvement in outcome' for this drug because physicians need access to all existing drugs, to treat patients in the best way."
German Payer 2
"Pharma must define the unmet need and patient populations that are going to be addressed with this product. If you're going to come in and say, 'Hey, we're going to be there for every Parkinson's patient out there,' I would say, 'Well, no. I already have a lot of drugs out there for your typical Parkinson's.' But if you're saying, 'Hey, we're really going after those patients who are experiencing a certain amount of off-periods per day.' Or in MS, 'We're going after patients who have disability progression on one prior service.' Or in epilepsy where they're going after patients who are still having seizures even after they tried two different products. So I prefer to have that right up front; defining unmet need and specific patient populations that they may be trying to address."
US Payer 2
What to expect
A detailed report exploring payer views and attitudes to pricing and reimbursement of innovative and biosimilar/generic neurology therapies for multiple sclerosis, epilepsy, migraine and neurodegenerative diseases:
Deliverables: Include PDF report and PowerPoint slide deck
Pricing and Reimbursement in Neurology: Evaluating Payer Strategies is delivered as:
Payer contributors
Payers contributing to this report have been screened to ensure they:
Payers interviewed included:
To ensure full and frank opinions were expressed we have agreed to keep the names of some contributors anonymous.
Why choose FirstWord ExpertViews?
FirstWord's ExpertViews reports reveal the real world insights of knowledgeable experts to analyze in detail key commercial and market trends that pharma management need to understand if they are to effectively respond to critical developments. These highly-focussed reports:
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