Power to the payer. Just weeks after a team of Memorial Sloan Kettering Cancer Center physicians criticized the high price tag of Sanofi/Regeneron’s new angiogenesis inhibitor Zaltrap in a New York Times editorial, the manufacturers responded by cutting the drug’s price in half. In a statement sent to media outlets, Sanofi emphasized its decision to reduce Zaltrap’s price tag was rooted in a desire to ensure patient access to the medicine, and cited “market resistance” … Continue reading
Discounting For Access: The QALY Math Is Spreading
Last week, England & Wales’ cost-watchdog NICE approved reimbursement for two drugs for advanced melanoma, Roche’s Zelboraf and Bristol’s Yervoy. As is so often the case at NICE, both drugs had initially been rejected, and both in the end came through with confidential discounts to the list-price. But this isn’t just a story about discounting, nor is it just about the UK. Everyone knows that winning reimbursement in England & Wales boils down to math – math that culminates … Continue reading
Actelion’s Opsumit Will Test Whether Outcomes Data Can Replace Head-to-Head
Actelion pulled out all the stops in designing the Phase III trial of its pulmonary arterial hypertension drug Opsumit (macitentan), filed at FDA on Oct 22. And no wonder: the biotech’s future depends on it, as its own top-selling PAH treatment Tracleer faces patent expiry in 2015. But Opsumit’s regulatory and reimbursement path should also interest any other drug developer seeking to test what kinds of data payers require in order to prioritize a next-in-class … Continue reading
The Value Debate: Can Personalized Drugs Support Personalized Pricing?
“Personalized health care requires a new reimbursement model,” declared Roche’s VP Global Pricing & Market Access Jens Grueger in the elegant London county hall debating chamber on Monday, at the Office of Health Economics (OHE)-sponsored gathering of payers, pharma and economists. The venue was appropriate. Debate centered around whether the move towards more personalized medicine could reasonably support more personalized pricing. Roche, with plenty of targeted medicines at stake, thinks, perhaps wishfully, that more differential, ‘value-based’ pricing is … Continue reading
Shifting Docs’ Incentives May Push Pharma Towards Portfolio Deals
As cost-of-care-focused experiments start — at last — to shift doctors’ incentives away from prescribing the most expensive treatment, there’s opportunity for pharma to offer ‘portfolio’ deals, spanning a range of drugs, and support services, across an entire therapeutic area. At least, that’s the view of Harvard Pilgrim’s CMO Michael Sherman, who is among the handful of payers testing new care delivery models with physician groups. You can hear more from him in this short … Continue reading
Sliding Away From Fee-For-Service: How CareFirst Does It
There’s been a lot of talk about the pros and cons of the standardization that comes from “Cheesecake Factory” style medicine since Atul Gawande published his thought provoking New Yorker piece. Like it or not, forward-thinking physician practices and payers are already embracing the concept. In oncology, look no further than John Sprandio, president of Consultants in Medical Oncology and Hematology and a pioneer in the oncology patient centered medical home movement, and Winston Wong, … 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
Payers, Churn & What It Means for Total Cost of Care
One question we get from pharmaceutical and diagnostic clients quite frequently: do payers really care about lowering the costs of care if the cost savings don’t show up for a few years? The problem they’re talking about is churn: a payer invests in a new cost-saving therapeutic program … only to see the savings redound to his payer-competitor when the patient switches plans (which they do every 3-5 years). Take adherence. It should be an … Continue reading
What Payers Want: An Interview with GSK’s Jack Bailey
Jack Bailey, the man in charge of GlaxoSmithKline’s US goverment affairs, public policy and payer marketing business unit, knows his company has to change. As providers and payers move from the incentives of a fee-for-service model to one that focuses on value, and are exploring new approaches such as risk-sharing and bundled payments, drug firms like GSK need to make sure that a “new medicine [has] a compelling value proposition, particularly for payers,” said Bailey. … Continue reading
The Prostate Cancer Battle: Can Xtandi’s Convenience Support a Premium Over Zytiga?
It may be Orion/Endo’s ODM-201, a potentially first-in-class anti-androgen to treat metastatic castration-resistant prostate cancer, that’s generating the most buzz ahead of this weekend’s European Society of Medical Oncology (ESMO) meeting in Vienna. But payers and physicians have a much more pressing concern: how to objectively evaluate two competing anti-androgens, Janssen’s Zytiga and Medivation/Astellas’s newly approved Xtandi, already on the market to treat advanced prostate cancer in the post-chemotherapy setting. A review of peer-reviewed published … Continue reading