Payment Reform

Smart Segmentation: Success in the Payer-Dominated Pharma Marketplace

Posted on Thursday, August 4, 2016

As physicians lose decision-making authority to payers, drug companies need to segment markets more effectively. In Vivo, July/August 2016, By Roger Longman / Email the Author / View Full Article As physicians lose decision-making authority to payers, drug companies need to segment markets more effectively.  In particular, they need to determine the patient populations prescribers are most likely to treat and that will spark the fewest access battles.  And they need to focus on the specific payer lines-of-business least inclined to block new drugs’ use. Please click here to read the full...

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PCSK9 Sponsors, Payers In The Ring At ACC

Posted on Thursday, April 14, 2016

Cardiologists bemoaned high cost of new drugs and high hurdles for reimbursement at the American College of Cardiology annual meeting; will outcomes data save the day? The Pink Sheet, April 11, 2016, By Emily Hayes / Email the Author / View Full Issue Sponsors of the PCSK9 inhibitors have been having a hard time fighting their way into the cholesterol market in their first year of launch. Cardiologists are wary of high prices for new drugs and payers have reportedly created an obstacle course for the doctors who are on board. The build-up of investor excitement over anti-PCSK9 monoclonal antibodies in the post-Lipitor era was fast and heavy, despite some awareness early on in their development of the risks of launching injectables in a market dominated by oral generics (“Will New Injectables Sell In An Oral, Mainly Generic Cholesterol World?” — “The Pink Sheet,” Apr. 9, 2012). With high LDL-lowering potency, good tolerability and a genetically based mechanism of action that is similar to statins, the PCSK9 class looked like a game-changer in cholesterol reduction, despite all of the available generics, especially without outcomes data (“PCSK9 Mechanism Lends Confidence Ahead Of Outcomes Data” — “The Pink Sheet,” Mar. 23, 2015). But performance of Amgen Inc.’s Repatha (evolocumab), approved in August...

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Medicaid May Offer Best Opportunity For Merck’s Zepatier

Posted on Wednesday, April 6, 2016

Newest hepatitis C entrant doesn’t have the best value in all subpopulations, according to analysis by Real Endpoints, but Medicaid’s mandatory discount could make up for those disadvantages. The Pink Sheet, March 28, 2016, By Cathy Kelly / Email the Author / View Full Issue Merck & Co. Inc.may find the unique drug pricing rules in Medicaid help create the best opportunity for its recently approved hepatitis C drug, Zepatier (grazoprevir/elbasvir), relative to prospects in the commercial and Medicare Part D markets. Zepatier is the third all-oral hepatitis C combination drug to reach the market and it has a narrower label than Gilead Sciences Inc.’s market-leading Harvoni (sofosbuvir/ledipasvir). To compensate for those challenges, Zepatier is positioned to compete mainly on price. Its wholesale acquisition cost is $54,600 for a treatment regimen, approximately 30% below Harvoni’s list price (“Merck’s Biggest Impact With Zepatier Approval May Be On HCV Pricing” — “The Pink Sheet,” Feb. 1, 2016). A recent analysis by RealEndpoints’ drug value and pricing tool RxScorecard highlights the complicated considerations that go into commercial strategies across the three major markets – Medicare, Medicaid and commercial plans – and shows how the pricing rules governing one sector, Medicaid, might offer advantages that the others do not. Merck is not indicating that its primarily focus for Zepatier will be Medicaid. The company told...

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Real Endpoints’ RxScorecard™ predicted launch failure of major new anti-cholesterol drugs

Posted on Thursday, February 11, 2016

Analysis from 2015 showed that because PCSK9 inhibitors had not proved more than incremental value for most patients, payers would dramatically restrict their usage. Poor Q4 sales show that’s exactly what happened. Westport, CT, February 11, 2016 In a press release issued July 7, 2015,  Real Endpoints LLC (RE) predicted that the two soon-to-be-launched PCSK9 inhibitors from Amgen and Regeneron/Sanofi would not get substantial market uptake. RE based this conclusion on its proprietary tool RxScorecard™, which assesses the relative value of marketed and pipeline drugs from a patient’s and payer’s point of view. RE defines value as a full assessment of a drug’s efficacy, safety, convenience, adherence and economic attributes in comparison to other therapies in the indication. RxScorecard indicated that while both products offered potential efficacy benefits, they demonstrated little incremental value for most patients because of their lack of meaningful outcomes data at launch and their expected high pricing. As a result RE said last July that “Payers will have an extraordinary opportunity to control costs in this class.” That’s exactly what they did. Now that Q4 sales are in for both Praluent and Repatha, the magnitude of their launch failure is clear. Praluent sold only $7 million in Q4; Amgen has not released data on Repatha,...

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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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Evidence and Endpoints in Cancer: Can Both Payers and Regulators be Satisfied?

Posted on Wednesday, March 27, 2013

How can oncology drug developers design their trials to satisfy both regulators and payers, and thereby maximize both access and commercial success?  It’s an increasingly urgent question as cancer programs continue to dominate pipelines, and drugs bills. Yet “there’s a fundamental tension” between the clear evidentiary base required to get a drug approved, and the emerging, sometimes inconsistent data sought by payers to justify funding that drug, notes Roy Baynes, SVP Oncology Therapeutics at Gilead Sciences Inc. Above all, he emphasizes the need for close engagement with payers, at least in Europe, from an early stage. Collaborating prospectively with governmental payers may help address the reality that “individual sponsors have little leverage,” he says.  (In the US, it’s not at all clear to us that payers want much to do with pharmas before products get very close to market.  And in oncology specifically, payers still can’t really say “no” to paying for products approved by the FDA; European governments have no such inhibitions.) There are some rules that now beginning to hold across the board, though, notwithstanding often considerable differences in evidentiary standards across treatment-type, positioning, and disease area. Having a “meaningful comparator is obviously important,” point out Baynes, who will be speaking at NextLevel Pharma’s PharmAccess Leaders’ Forum in...

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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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As Pressure Builds on US Prices, Is Pharma Ready?

Posted on Friday, December 14, 2012

Free drug pricing in the US has fewer than five years to run, thanks to mounting pressure on health care spend and resulting efficiency drives.  That’s the message to pharma investors, be it from fund-managers speaking at Bloomberg Industries Healthcare event in London on Dec. 10, or from analysts such as as Citi’s Andrew Baum. It’s tempting not to believe it. After all, for now, US drug price increases are actually at a five year high in the mass retail market, according to Bloomberg Industries’ healthcare research director Sam Fazeli. And hospital drug price increases, too, have rebounded since 2009. “For now, the game’s the same in the US: you can price at whatever you like,” he concluded.  With Europe on its knees, status quo in the US is what many pharma are relying on. They’d better make sure they have a plan B when the dream ends, though. “There’s a lot of momentum behind evidence-based therapy and paying-for-performance in the US. We have to be ready to hear about how some of that translates into drug pricing,” warned fund manager Dan Mahony of Polar Capital Holdings at the Bloomberg meeting. Zaltrap provided an early example of drug price pressure in the US: Hit hard by Memorial Sloan Kettering’s decision not to use it –...

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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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