Pharma and Payers – Building Better Relationships

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Publication date:
September 2012
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Changes in the healthcare landscape have put payers (public and private) under mounting pressure to reduce the cost of care, and given them much greater influence over market access to new medicines.

In this new environment, regulatory approval of new drugs no longer guarantees favourable pricing and formulary placement. Instead, payers focus increasingly on value to determine pricing and access.

Drug developers need to understand the value review process, and adapt their organisation to engaging payers early in the journey. More profoundly, pharma companies must find ways to evolve their current transactional, and even adversarial, relationships with payers to more collaborative ones. After all, Pharma and payers share the same ultimate goals – to lower costs and improve care.

This new report helps Pharma and payers build a “win-win” relationship; by understanding each other’s needs, and by exploring new opportunities for collaboration.

Key features of Pharma and Payers – Building Better Relationships include:

  • Detailed insights into what payers want from Pharma (and vice versa)
  • Recent case studies of collaborations between major pharma companies and payers
  • Practical advice on meeting payers’ needs and tackling potential problems
  • Review of the growing influence of patients/consumers
  • Description of different types of payers
  • Guide to the payer frameworks in key markets (US, UK, and the leading European pharma markets: Germany, France)

Key Benefits

This extensive report includes a wealth of information and tools that empower Pharma and payers to work together more effectively, with the ultimate goal of offering patients access to life-saving drugs, biologics, and vaccines.

After painting a detailed picture of the current environment (including explaining regional payer systems, and key factors driving change), the report offers a fascinating exploration of “what payers want”. You’ll learn about the primary ways in which payers are measuring outcomes (e.g., QALY, CER, pragmatic clinical trials), and discover best practices in resource allocation, organisation, communication, and accountability.

The report includes real case studies of successful pharma-payer partnerships (such as risk-sharing agreements, clinical outcomes studies), and draws on expert opinions and advice from more than a dozen of the world’s foremost thought leaders and executives in this space. This report will help you to:

  • Learn from successful collaborations between payers and Pharma
  • Understand what payers expect and want from Pharma
  • Improve Pharma-payer communications
  • Optimise your organisational structure to meet payer needs
  • Be aware of potential pitfalls
  • Generate successful drug pricing and formulary placement discussions
  • Be ready for future developments

Pharma and Payers – Building Better Relationships
answers key questions including:
  • What kinds of data (e.g., around safety and efficacy) are most useful for improving market access?
  • What are the key differences and common denominators between the payers in the US and key European markets?
  • Who are the best people to represent Pharma in payer negotiations?
  • At what stage of drug development should the payers, or pricing and reimbursement consultants, become involved?
  • What kind of risk-sharing arrangements can be made between pharma and payers?
  • What opportunities are there for win-win collaborations?

Selected Quotes

“It is no longer simply about drug cost but total cost of care to demonstrate a product’s value. Pharma is beginning to understand that.” Dr. Marcus Wilson, vice president, WellPoint, HealthCore Inc

“If drugmakers haven’t got the relevant health economic data together to support the price of a new drug then it’s never going to float.” Michael Morgan-Curran, director, mHealth Diabetes, GSMA; director/owner, MM-C Innovative Solutions

“Each payer is different and to create and maintain long term mutually beneficial relationships, pharmaceutical companies must understand a payer’s environment, the way they work, their needs and drivers.” Elliot Rosen, managing director, Accession Healthcare Consultancy