Is Pharma Equipped to Prove Value?

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Kim Wishnow-Per
Managed Markets
President, McCann

One of the most difficult barriers for access teams to overcome with payers is being able to fully and credibly illustrate how brand utilization can lead to better patient outcomes at launch. While more pharmacoeconomic endpoints are now included in clinical trials for new drugs, what is really needed is a credible unbiased third-party tool to demonstrate that a brand is delivering better outcomes in the real world. Lacking this third-party tool, clinical trials would need to have many thousands of patients enrolled to demonstrate better outcomes at launch. However, once a brand has been on the market, real-world evidence can be collected and published in peer-reviewed journals to demonstrate improved patient outcomes for a brand.     

Steve Stefano
Ashfield Market Access
Managing director

There are occasions when market-access teams have pharmacoeconomics data to present an outcomes-based case, but the general perception is that this doesn't get a lot of traction, particularly when working with run-of-the-mill retail brands. If the brand is a high-ticket item—a $10,000 cancer treatment, an orphan drug, a high-profile cure for hepatitis C—then there is benefit in net analyses and it is in the best interest of the sponsoring company to make these tools available. But when working with brands in crowded markets with little differentiation, presenting clinical data that demonstrate a brand's safety and efficacy along with inherent healthcare benefits is key. Then it comes down to simple economics: your brand's suggested price versus others in its field. A good market-access rep knows this inside and out.

Joshua Greenblatt
Managed Markets
SVP, Medimedia

Value-based market access tools developed by manufacturers, which are also relevant to customers, are rare. Why? These reasons come to mind. No single definition of value. Individuals and organizations assess value from their own perspective, requiring highly customizable tools. A lack of clear guidance from the FDA and FDAMA 114 on what is permitted in promotional material to population decision makers. Finally, we don't have a great deal of strong cost-effectiveness evidence, partly because manufacturers don't capture the data that payers need to make decisions about products. It's difficult to show value for treatments addressing end of life. High costs and results measured in months of added life challenge payers, leaving value to be determined by patients and their families.

Scott Baxter
Market Access
President, Healthstar

Market-access teams need more value-based materials and programs. The shift to demonstrating value beyond the price of the product is now a primary theme of the review process at all payers. That the industry understands this is evident, as increasing numbers of outcomes-based studies and initiatives are being completed. As this shift continues, we are seeing budgets adapt, allowing more value-based presentations and account manager–led programs with key stakeholders at both traditional payers and within integrated delivery networks. We will see a greater shift as companies align with this new trend over the next few years. 

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