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Value-Based Dealmaker

What is all the hype about?

First, the rest of the U.S. healthcare system is moving towards value-based arrangements — paying for results, not activity. The drug industry will follow. Second, traditional contracting hasn’t worked for most companies: payers have learned how to block access, even to the most innovative new medicines. Value-based (VB) deals offer an evidence-based way forward.

BENEFITS of Value-Based Deals

MANUFACTURERS are able to …

  • Gain payer access to drugs faster, increasing total sales
  • Distinguish a drug vs. competition
  • Generate real-world evidence
  • Foster goodwill with payers and the public

PAYERS are able to …

  • Pay for drugs when they work, not when they don’t
  • Demonstrate value of drug spend to employers
  • Bridge the evidence gap for new drugs approved with scant data
  • Create greater economic predictability

CHALLENGES of Value-Based Deals

BOTH face varying hurdles …

  • Minimizing the expense and resources required to structure and monitor VB deals
  • Structuring a VB deal to have true economic impact
  • Managing downside risk for both sides
  • Complying with Medicaid Best Price rules
  • Identifying relevant data sources that are not expensive or onerous

How can we maximize benefits and minimize challenges
to both manufacturers and payers?

Select only the right drugs for VB deals and industrialize the process

Select the right drug…

PHASE 1:

Assess VB deal fit

  • Clinical differentiation
  • Budget impact by payer segment
  • Market environment

PHASE 2:

Design contracts & initiate pilots

PHASE 3:

A Real Endpoints Solution

Is a VB deal appropriate?

YES

Example criteria

  • Multiple moderately differentiated competitors for major condition launching closely together
  • High predicted economic impact and variable efficacy
  • Straightforward/relatively inexpensive to obtain required data

NO

Example criteria

  • Drug is inferior
  • High societal/medical impact vs. pressure to reimburse and no competition
  • Data required too hard/expensive to gather
  • Competitor economics make VB deal unattractive (i.e. significant rebates for plan)

…Then, industrialize the process

PHASE 1:

Assess VB deal fit

PHASE 2:

Design contracts & initiate pilots

  • Create contract archetypes
  • Use RE’s data templates
  • Establish adjudication process
  • Filter target payers

PHASE 3:

Roll out nationally

  • Collaborate with pharma's contracting process

Why Real Endpoints?

Trusted third party using evidence-based, transparent medical and financial analysis

Strong relationships with leading-edge payers and IDNs

Unique, industrialized VB deal process using standardized deal archetypes and templates

Experienced Real Endpoints is orchestrating numerous VB deals between biopharmas and payers/IDNs