Payer Management Tool

‘DrugAbacus’, a Comparative Cancer Drug Pricing Platform Powered by Real Endpoints’ RxScorecard™, is Launched

Posted on Friday, June 19, 2015

Westport, CT, June 19, 2015 – Real Endpoints (RE) is pleased to announce that its RxScorecard™ is the information technology platform supporting Memorial Sloan Kettering Cancer Center’s DrugAbacus – an interactive tool for considering the basis of cancer drug prices. Conceived by Dr. Peter B. Bach, Director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering (MSK), DrugAbacus was launched at MSK’s DrugAbacus generates a dollar-value for cancer drugs available in the United States (beginning in 2001 with Gleevec) based on a user’s settings for six different domains of potential value including the treatment’s survival benefit, side effects, and the incidence of the condition targeted. Memorial Sloan Kettering licensed the Real Endpoints RxScorecard platform for research purposes so users can generate “Abacus prices” and compare them with actual prices of these drugs at the time of launch in a visual and intuitive format. “We believe RxScorecard is the only tool available that provides a 360 degree comparison of the multiple components of a drug’s value in an independent, objective and systematic approach. We developed the IT platform to make it very easy for users to access our analysis, and are delighted that Dr. Bach selected this platform for DrugAbacus,” said Julie Eskay Eagle, RE’s Vice...

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Wall Street Journal publishes article on new cancer pricing tool from Memorial Sloan Kettering using RE’s RxScorecard technology

Posted on Friday, June 19, 2015

June 19, 2015 – Memorial Sloan Kettering Cancer Center, one of the nation’s top cancer hospitals, has created an interactive calculator that compares the cost of more than 50 cancer drugs with what the prices would be if they were tied to factors such as the side effects the drugs produce, and the amount of extra life they give patients. Please click here to access the article....

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UnitedHealth-Mayo: More Data, More Open. But Not Quite Neutral

Posted on Tuesday, January 22, 2013

UnitedHealth’s outcomes-focused research alliance with Mayo Clinic, announced Jan. 15, reminds us of big data’s central role in creating a value-driven US health care system.  The tie-up claims to have created the biggest-yet trove of claims-plus-clinical patient records in the US, combining over 100 million claims records from United’s Optum’s health services division with over 5 million clinical records from Mayo. As such, it’s powerful. Collating top-level insurance claims with in-depth clinical reports is as good as it gets right now for real-world-evidence hunters; it paints the most complete picture of patients’ disease progression that’s available large scale. That’s why payers and drug firms that have already teamed up in the quest for RWE are striving to bring providers into the fold. (You can hear more about AstraZeneca and partner HealthCore‘s efforts to build a consortium at the Real Endpoints’ Symposium on March 11-12.) Optum and Mayo are likewise inviting other organisations to contribute to, and fish in, this pool of longitudinal data: the alliance takes the physical form of Optum Labs, an ‘open innovation facility’ where players – including drug firms, payers, providers, academics – can, with further resources and questions of their own, “come together to conduct research, innovate and improve outcomes for patients,” said Andy Slavitt, Optum’s group...

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The Drug Assessment Process: Inadequate and Costly

Posted on Wednesday, January 16, 2013

The more I study it, the more I believe the process of drug assessment by payers and providers needs some serious attention (we’ll pay plenty at the Real Endpoints Symposium, March 11-12). But driving action requires concern — and so, who cares?  Answer is: anyone interested in improving the dismal economics of healthcare.  As we noted here, drug-spend inflation is skyrocketing, thanks largely to the cost of new drugs and, in particular, new specialty drugs.  And the best mechanism we have for controlling those costs is the process, led by Pharmacy & Therapeutics committees, for assessing the value of drugs and establishing utilization guidelines.  But best, in this case, doesn’t mean adequate. Most obviously, the process is redundant.  Several hundred payers and several thousand hospitals all have P&T committees, with associated clinical pharmacy specialists and other research infrastructure, looking at the same materials about the same drugs…and by and large coming up with pretty similar answers. It’s slow and under-productive.  Based on our admittedly unscientific survey, P&T committees at most mid-sized and smaller plans meet quarterly and make decisions on, maybe, 13-15 new drugs per year.  They don’t have the time or bandwidth to re-assess new data on existing drugs that could change their formulary status. It’s oddly limited. ...

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Why Payers Don’t Really Control the Drug Benefit — and Why They Need to

Posted on Tuesday, January 8, 2013

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 the David Shaywitz/Tony Wolff skeptical take on at least the digital aspect of all this) . But relatively little of this re-engineering aims at the purchase and management of drugs.  (We’ll be talking about the most important innovations at the Real Endpoints Symposium, March 11-12, in Philadelphia). There are a few experiments on the margin.  Some payers are playing with tougher formularies (e.g., UnitedHealth de-preferred major market leaders Januvia and Humira, with significant success in moving the former’s market share to Onglyza and less success with Humira).  “Pathways” in oncology (attempts to standardize physicians on specific drugs) show promise.  And now that Medicare, through its star ratings, is paying plans to improve adherence, there’s an opportunity for new models that predict when patients will adhere to their meds and when they won’t. (For the...

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Reimbursement “Furies” Real, But Won’t Avenge Pharma Til 2017, Says Citi

Posted on Tuesday, December 4, 2012

“Beware the Three Furies,” warns Citi analyst Andrew Baum.  In a report for pharma investors published Nov. 29., Baum turns to classical mythology to describe shared savings models, drug pathways and ACOs — the forces that will soon dominate US health care plans. He’s chosen an interesting analogy: The Three Furies were goddesses of vengeance, who punished the wicked for their crimes; they’re also described as “tormenting those who have yet to atone for their sins”. So we, and plenty of others, agree that pharma should be nervous. “Reimbursement, not R&D pressure,” is the is the biggest risk facing pharma investors, writes Baum. But although “alarmed” by the drivers, and potential consequences, of US healthcare cost containment (particularly given the dire state of the EU), Baum reckons drug firms’ earnings won’t feel the full brunt of US pricing pressure “until at least 2017.” He argues that for the next five years, the revisions to the US healthcare system will have the greatest impact on medtech, hospitals, and diagnostics, with less focus on pharmacy-related costs.  Even in the case of drug pathways, singled out as the most important long-term structural risk to the biopharma industry “meaningful adoption will remain slow” in Baum’s view. To back that up, he cites research by...

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Sanofi Blinks First: Zaltrap Price Cut Proves HTA Has Reached The US

Posted on Monday, November 12, 2012

Sanofi’s decision last week to cut the price of its colon cancer drug Zaltrap by up to 50% showed that the US market is no longer immune to European-style drug price pressure. Never mind that the move was partly a result of a messed-up calculation on Sanofi’s part: this was a defining moment in the evolution of America’s troubled health care system. That the price of a drug was cut at all, and voluntarily (albeit under pressure), is notable enough: prices usually go up, especially in the US. But the size of the cut (deeper than almost all of the discounts squeezed out of pharma by European cost-watchdogs’ rule-dominated systems), and the fact that we’re talking about a drug for cancer (until recently among the most price-protected TAs) that’s, technically at least, an NME, is even more remarkable. Zaltrap’s high price of $9-11,000 per month, its questionable efficacy (extending overall survival by just 1.5 months) and safety concerns such as a boxed warnings over fatal GI bleeding were what prompted leading cancer specialists at Memorial Sloan-Kettering Cancer Center to boycott the treatment. The MSKCC scientists were behaving just like an EU-style health technology assessment agency: they were in effect importing the spirit, if not the institution, of a NICE-like hurdle to the US. (There’s no way, incidentally, that Zaltrap...

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Risk-Shares Pop Up Again As Payers, Pharma Circle New Payment Models

Posted on Wednesday, October 3, 2012

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? That won’t eliminate the need to rebate (that’s a permanent fixture with me-too drugs) But it may limit it – and, potentially, allow a reduction in the rebate going forward. Here’s how such a contract might work. In exchange for covering drug A, the payer gets discount X. If the drug meets a certain tolerability threshold (defined, of course, relative to the competitor) that discount remains. If it doesn’t, the discount deepens. In the future, if that tolerability data can be turned into reduced overall cost (side-effects, treatment switching costs) the discount may shrink. Impracticable and unlikely to pass muster with payers, you say. Generally speaking, you’d be right. Exhibit number one supporting your conclusion: the paucity of risk-sharing in the US to date. Exhibit number 2: payers’ publicly disclosed reasons for this scarcity,...

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The Big-Data Race Is On. But Real World Evidence Won’t Solve Pharma’s Trust Problem

Posted on Thursday, September 27, 2012

As payers step up their hunt for drugs’ ‘value’ – defined, in their eyes, in terms of outcomes — so pharma is scrambling for real world data that can prove how well their products work in practice. Pharma faces two key challenges in doing this. The first is generating or accessing enough high-quality information to ensure statistical reliability. The second (tougher) challenge: persuading payers to trust it.  We’ll be addressing both of these at our Real Endpoints Symposium on Nov. 1-2, with help from those executives involved in some of the highest profile real-world evidence (RWE) collaborations yet crafted. In theory, the bigger the data-set interrogated, the clearer the picture should be — just as larger clinical trials are generally more powerful than smaller ones. That was at least part of the rationale behind information provider IMS Health’s mid-September tie-up with Health Intelligence Company (HIC), to access what’s said to be the biggest commercial claims database in the US. The HIC database — which draws on lives covered by Blue Cross Blue Shield plans — provides medical and pharmacy details for over 110 million lives, apparently trumping in terms of both volume and geographic scope what individual payers like United Health (70 million plus covered lives) or Humana (about...

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The Real-World Evidence Buzz Now Matters As Payers Push For Risk-Based Pricing

Posted on Friday, September 14, 2012

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 at the lowest cost, then they’d be sleeping a lot easier right now. Cancer pathways, medical homes and the entire ACO wave all involve measuring and interpreting outcomes (aka RWE). But these experiments are in their infancy. And they don’t involve individual drugs; they look at overall treatment regimens. There are –relative to the number of products on the market — very few examples to date of where outcomes data has led explicitly to a change in coverage for a drug.  At one extreme, real-world evidence of harm caused by thalidomide, approved to treat nausea during pregnancy, led to that drug’s withdrawal during the 60s but that was a regulatory decision. So was Avastin’s revoked breast cancer label. But the dearth of concrete examples of RWE driving yes/no coverage decisions belies a growing wave of...

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