Payers: Managed Medicaid/Medicare

Who Has the Power to Cut Drug Prices? Employers.

Posted on Tuesday, December 1, 2015

Harvard Business Review, December 1, 2015 by Robert Galvin, MD and Roger Longman Why do medications cost so much, particularly specialty drugs that treat the most serious conditions? Mostly because U.S. drug companies can price them however they want. But pharmaceutical companies don’t deserve all of the blame for high drug prices. Lots of other actors in purchasing, distribution, and brokerage have greater incentives to keep prices high than to lower prices or choose drugs that reduce longer-term medical and business costs, like absenteeism.  Employers have the greatest potential to influence some of those actors and, ultimately, to chip away at high drug prices. But to appreciate the power that employers have in this area, you must first understand how competing incentives work in the world of drug pricing. Click here to read full...

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‘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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Deal Away, But Don’t Forget What Payers Think

Posted on Thursday, January 10, 2013

As pharma and biotech execs at JP Morgan in San Francisco craft the next round of life- and/or growth-extending deals, they’ll hopefully remember that the key issue is now reimbursability, not approvability. A survey released this week by BayBio, the California Research Institute and PwC (flagged up by Xconomy) provides a timely reminder. More than half of the 157 Californian-biotech CEOs questioned said that securing insurance coverage and reimbursement for their products became more difficult in the past year; meantime there were fewer reports of FDA-linked delays. The growing payer-challenge is already reflected in the next round of large mergers touted by bankers. Among the $10 billion-plus candidates is eye-care group Bausch & Lomb – less because it’s in a sexy specialist ophthalmology niche, than because most of its products avoid the payer challenge altogether: they’re non-reimbursed OTC treatments (such as contact lens fluid) and generics. Licensing transactions, too, are now being valued at least in part according to reimbursement-linked criteria. “We spend a huge amount of time” testing potential in-licensing candidates with payer and physician groups, claimed AZ’s business development chief Shaun Grady on a panel at BIO last year.  Targeted products for well-defined diseases (rare, symptomatic ones if possible) feature high on the reimbursability scale. That’s why companies like Epizyme are...

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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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Actelion’s Opsumit Will Test Whether Outcomes Data Can Replace Head-to-Head

Posted on Friday, November 2, 2012

Actelion pulled out all the stops in designing the Phase III trial of its pulmonary arterial hypertension drug Opsumit (macitentan), filed at FDA on Oct 22.  And no wonder: the biotech’s future depends on it, as its own top-selling PAH treatment Tracleer faces patent expiry in 2015. But Opsumit’s regulatory and reimbursement path should also interest any other drug developer seeking to test what kinds of data payers require in order to prioritize a next-in-class therapy that’s likely to be somewhat –but not necessarily hugely — better and safer than existing, soon-to-be-much-cheaper treatments. Opsumit treats a rare, but not ultra-niche condition. It has orphan status, but is a follow-on drug (albeit a highly optimized one) in an increasingly competitive, and genericizing, segment. Phase III data strongly suggest this dual endothelin receptor antagonist has dosing, safety and efficacy advantages over existing PAH treatments. Can Longer-Term Outcomes Data Replace Head-to-Head? But Actelion didn’t pit Opsumit directly against Tracleer or Gilead’s Letairis, the one-two of PAH, for familiar reasons – not least because to adequately power the research, it would have required conducting a large (e.g 5000-patient) and expensive trial.  Instead, it designed a trial that was much longer, and with more outcomes-focused endpoints, than any other PAH study. The placebo-controlled SERAPHIN trial,...

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Shifting Docs’ Incentives May Push Pharma Towards Portfolio Deals

Posted on Tuesday, October 9, 2012

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 podcast, and at the Real Endpoints Symposium on Nov. 1-2. One of Harvard Pilgrim’s ‘total-cost-of-care’-focused pilots is around bundled payments for diabetic care. For now, it doesn’t include drugs — but, given their contribution to the budget, Sherman would love it if they did. “The pilots can happen without pharma, but they’d be more powerful with,” he says. Most drug firms aren’t in a hurry to sell their products as part of a bulk-buy approach — not least because of the precedent this may set for individual drug prices. But a few, especially those working in me-too-heavy areas like diabetes, are open to the idea. “Companies with a rich TA-specific portfolio might be able to have a good discussion with payers” about a bundled or “all-you-can-eat”deal, says one pharma market access director. The pharma may...

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