While Accountable Care Organizations and demand for drugs that have a quantifiable life and savings impact have been a focus of pricing and marketing discussions, advisory firm EY (formerly known as Ernst & Young) added another perspective to the “is-this-drug-worth-covering” conversation Wednesday with the release of its analysis of the payer space.
The report is called “EY Progressions 2014: Navigating the payer landscape.” The short of it is that ACOs and payers have distinct criteria for what makes a drug worthwhile, and pharmaceutical companies are failing to recognize unique payer communication needs.
Among EY’s findings were that payers are highly focused on immediate cost containment, which means that the longer-view approach that emphasizes outcomes and keeping total costs down is irrelevant to payers. EY points out this means popular marketing points, such as programs that increase drug adherence and patient engagement, does not move payers to say yes to a drug.
An additional data point of note: 88% of surveyed payers told EY drug prices are a major reason healthcare costs are rising, while only 42% of surveyed industry insiders agreed.
EY also found that pharma is a bit off when it comes to explaining why their drug should be considered and notes that payers are more interested in comparative data sets than they are in clinical trial data, yet the pharma industry regularly serves up data that only compares their drug to a placebo. Further, EY’s findings show that payers put a premium on real-world results.
Possibly adding more pressure to the data pharma can provide and what payers want is that payers do not trust the industry to be straightforward. EY found that less than 50% of the surveyed payers “find the industry’s data to be credible.”
EY did, however, find some overlap between payers and treatment decision makers, which is that although payers may be open to new drugs, the label “new” has to be supported by robust information that shows a clear advantage over what is already on the market. Researchers found that payers are also circumspect when it comes to what qualifies as innovation, with just 20% saying “new pharma products are significantly differentiated from standard-of-care.”
Lastly, researchers found that while payers may not be won over by industry’s patient-engagement efforts, they want pharma to engage payers in a way that addresses their value and competencies, and want discussions that “are not mere negotiations around access and price, but…relationships” that help payers address their challenges.