Payers want pharma to address the challenges they face
Specialised cancer therapies such as checkpoint inhibitors have significantly improved outcomes for patients—but for payers they represent a growing pricing and reimbursement (P&R) challenge, especially as triple and quadruple oncology therapy becomes more commonplace. To achieve formulary position and the widest possible prescribing, pharma needs payers positively on board, so what practical steps can developers take to get payer support for their oncology product's pricing and reimbursement ambitions?
Understanding the pressures and touchpoints that resonate with payers is critical. That is why, in February 2020, we interviewed 8 experienced US and European payers in Pricing and Reimbursement in Oncology: Payer Views to reveal their attitudes and needs and the practical steps pharma can take to address their concerns.
Payers explore key questions such as...
What payers say...
"When I look at economic value, I'm going to look at, is this product tax-offset in a hospitalisation or an ER visit? If you're telling me it's $100,000 a year for a drug and I'm offsetting or reducing the total cost of care, then I would say yes. But, we don't see that data. Is it justifiable for me to say a manufacturer can charge $250,000 for their oncology products because it's a cellular carcinoma that's a very rare condition? I don't know. As a payer, I'm not sure what I'm getting in return. It's justifiable if they're showing me that I'm reducing total cost of care [and] we don't get that kind of evidence from the manufacturers. "
US Payer 2
"I think we all want to see real world data, but many times I think, depending on who's publishing and if we know that it's published by a pharmaceutical company, it's looked at with a bit of a jaundiced eye. Of course, we're not expecting to see anything negative if it was published and supported by a manufacturer. So, I think a lot of real-world data is interesting, but lacks credibility. One of the things I always suggest to pharma is, maybe leverage an academic centre, a credible institution and integrate it. [For example] if something was published by Kaiser, it could still be sponsored by pharma, but it would lend so much more credibility if it was actually done through a very credible source and allow that source to publish on behalf of pharma. Real-world data is always powerful, but often it lacks credibility because of the potential bias."
US Payer 3
I don't think every payer has the time or the resources to really get involved with clinical trial design, nor is that really their expertise. But I do think that manufacturers could engage with payers in forums to understand what's important, and what might be a differentiator as they consider development of those trials. And then I think it's extremely important, instead of waiting until the drug is on the market, to come at least a few months prior to launch to start talking about the product and the disease state, and really get that contracting strategy nailed down. I've seen them come in and present what the study is and what they're looking at. Then they ask for feedback. For example, what do you think about this? What else would you want to see for post-marketing surveillance for future trials? But not for those initial pivotal trials."
US Payer 5
What to expect
Expert contributors
Experts contributing to this report have been screened to ensure they:
Contributors include
To ensure full and frank disclosure of opinion some of the contributors have remained anonymous.
Why choose FirstWord ExpertViews?
FirstWord's ExpertViews reports reveal the real world insights of knowledgeable experts to analyse 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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