UnitedHealth’s outcomes-focused research alliance with Mayo Clinic, announced Jan. 15, reminds us of big data’s central role in creating a value-driven US health care system. The tie-up claims to have created the biggest-yet trove of claims-plus-clinical patient records in the US, combining over 100 million claims records from United’s Optum’s health services division with over 5 million clinical records from Mayo. As such, it’s powerful. Collating top-level insurance claims with in-depth clinical reports is as good … Continue reading
The Drug Assessment Process: Inadequate and Costly
The more I study it, the more I believe the process of drug assessment by payers and providers needs some serious attention (we’ll pay plenty at the Real Endpoints Symposium, March 11-12). But driving action requires concern — and so, who cares? Answer is: anyone interested in improving the dismal economics of healthcare. As we noted here, drug-spend inflation is skyrocketing, thanks largely to the cost of new drugs and, in particular, new specialty drugs. … Continue reading
Why Payers Don’t Really Control the Drug Benefit — and Why They Need to
It’s certainly the biggest change in healthcare in my business lifetime: the transformation from a fee-for-service economy fueled by abundant dollars to an essentially capitated world of financial tradeoffs. The transformation will likely take longer than we expect. (What transformation doesn’t?) Still, payers and providers –and the various big and small service providers hoping to serve them — are already trying to improve swaths business processes as diverse as connectivity, transparency, and consumer communication (see … Continue reading
Reimbursement “Furies” Real, But Won’t Avenge Pharma Til 2017, Says Citi
“Beware the Three Furies,” warns Citi analyst Andrew Baum. In a report for pharma investors published Nov. 29., Baum turns to classical mythology to describe shared savings models, drug pathways and ACOs — the forces that will soon dominate US health care plans. He’s chosen an interesting analogy: The Three Furies were goddesses of vengeance, who punished the wicked for their crimes; they’re also described as “tormenting those who have yet to atone for their sins”. … Continue reading
Sanofi Blinks First: Zaltrap Price Cut Proves HTA Has Reached The US
Sanofi’s decision last week to cut the price of its colon cancer drug Zaltrap by up to 50% showed that the US market is no longer immune to European-style drug price pressure. Never mind that the move was partly a result of a messed-up calculation on Sanofi’s part: this was a defining moment in the evolution of America’s troubled health care system. That the price of a drug was cut at all, and voluntarily (albeit under pressure), is … Continue reading
Risk-Shares Pop Up Again As Payers, Pharma Circle New Payment Models
Say you’re GSK, and a head-to-head trial pitting your drug against the market leader showed non-inferiority. Say, too, that even though you assembled some trial evidence that patients preferred your drug vs. the leader, this hadn’t convinced everyone. So, with 70% of prescriptions still favoring your competitor, what to do? Blunt rebating is one option – but hardly commercially attractive. So how about taking the risk of testing your tolerability claim in the real world? … Continue reading
The Big-Data Race Is On. But Real World Evidence Won’t Solve Pharma’s Trust Problem
As payers step up their hunt for drugs’ ‘value’ – defined, in their eyes, in terms of outcomes — so pharma is scrambling for real world data that can prove how well their products work in practice. Pharma faces two key challenges in doing this. The first is generating or accessing enough high-quality information to ensure statistical reliability. The second (tougher) challenge: persuading payers to trust it. We’ll be addressing both of these at our … Continue reading
The Real-World Evidence Buzz Now Matters As Payers Push For Risk-Based Pricing
Everyone’s talking about real-world evidence (RWE). But should pharma care? Is it driving coverage decisions? The answer’s getting closer to ‘yes’. (For proof of that, join a frank payer-pharma discussion on the subject at our RE Symposium November 1-2.) There’s good reason to be talking RWE: in theory, it’s the key to a more efficient, sustainable health care system. If payers and providers could track which drugs and treatment pathways lead to the best outcomes … Continue reading
Managing Molecular Diagnostics: The View from Aetna’s Ira Klein
What could be more intuitive than providing the right medicine to the right patient at the right time? Alas, the actual implementation of personalized medicine is frustratingly imprecise—and, increasingly, expensive. And that’s a big concern for payers who wrestle with questions of cost, and what constitutes clinical validation and utility when making diagnostic coverage decisions. Not only is it a topic of discussion at our inaugural Real Endpoints Symposium (taking place November 1-2 in Philadelphia). … Continue reading
Does AZ’s Iressa Single Payment Scheme Point To Risk-Sharing’s Future?
We’ve set out our position as far as the future of risk-sharing’s concerned: there is one. And all the more so in the UK, given that cancer funding is about to get a lot tougher. The £600m ($970m) Cancer Drugs Fund, set up as a political quick-win to relieve the restrictions on access to oncologics, is due to end in 2014. The fund helped pharma in negotiations, “because they knew money was available,” says one UK payer. But … Continue reading