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
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
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
Risk-Sharing: Not Easy, But Impossible To Ignore
So risk-sharing deals haven’t taken off with the gusto that their compelling logic suggests they should have. Even in Europe — the ripest territory for such contracts, given the alternative may be no reimbursement at all — there have been only a dozen or so deals. And several of those are mostly about sharing financial risk, rather than tying price or indeed payment to performance and outcomes. The hurdles are better documented than most of … Continue reading
The Healthcare Round-Up: 3/7 – 3/13
The Legality of Co-pay cards: It’s no secret co-pay cards are a contentious issue; now, they’ve been taken to the courts. Last week, the consumer advocacy group, Community Catalyst, filed suit against 8 drug companies seeking to ban the use of co-pay cards on behalf of unions that provide drug benefits for civilian and uniformed municipal workers in New York City, carpenters in New England, and plumbers in various states. Among the drug companies specifically … Continue reading
Payer's Delight: European Drug Prices Could Spiral Downward Thanks To Germany
A little-reported fact about Germany’s new early-benefit assessment system (AMNOG to most people) is that the current law requires making public the rebates agreed to between drug firms and the country’s sick funds association (GKV). That’s a huge departure from the current cozy situation, where only ‘list’ prices are revealed. (That’s the case in most other key markets, too). And it matters to drug firms, since close to 30 countries in the world, including 19 in … Continue reading
Innovative Contracting: Healthcare Reform A Key Catalyst
By Katya Svoboda and Alexis Matos Given the difficulty of implementing risk-sharing deals in Europe, should manufacturers in the U.S. even bother setting up these complex arrangements? After all, these innovative contracts, typically tied to a drug’s performance, are notoriously tough to put in place. In many cases the systems required to capture the relevant data are missing, and the lack of coordination between medical and pharmacy benefits means conflicting incentives could be operating within … Continue reading
The Healthcare Round-Up: 12/26/11 – 1/4/12
It’s hard to jump back into work after two weeks of drinking egg nog, eating springerle and lebkuchen, and debating healthcare reform with the in-laws. That’s why Real Endpoints is here to help. In today’s edition of “The Healthcare Round-Up”, we’ve pulled together the best healthcare/ reimbursement related news you may have missed as you were counting down to 2012, finalizing your too-packed J.P. Morgan Healthcare conference calendar, or discussing the merits of Teva’s new … Continue reading
Set The Price Up Front: Iressa Single Patient Access Scheme Shows How Risk-Sharing Can Work
AstraZeneca may have figured out how to make risk-sharing work in the U.K. – and even beyond. My last post highlighted how some programs, like J&J’s Velcade Response Scheme, are too complex and costly to administer, and thus don’t work – at least not for the payer. AstraZeneca’s Single Payment Access (SPA) scheme for lung cancer drug Iressa, recommended as part of cost-watchdog NICE’s nod to the drug’s reimbursement in May 2010 isn’t simple. National Health … Continue reading
Putting A Price On Eylea: Why Regeneron's Decision Matters
Kudos to the commercial team at Regeneron for understanding that reimbursement is an environment. That is: Regeneron doesn’t think that payers are the only ones who matter in the reimbursement decision. Just before Thanksgiving, the company took the unusual step of announcing it would price its newly approved wet AMD treatment Eylea at a discount to the standard-of-care Lucentis. “We feel the price is fair to physicians; it is also fair to Medicare,” SVP of … Continue reading