Payer Insights: Hepatitis C
The race is on for the company that can competitively price treatment regimens, share data on clinical benefit/positioning and support patient initiatives.
Payer Insights: Hepatitis C, based on in-depth interviews with 12 leading healthcare payers in the US, is packed with hard-hitting, candid opinions and advice on how, from their perspective, Pharma can get it right in the future.
Gilead’s commercial success with its ground breaking HCV treatment Solvadi has been matched by the opposition of healthcare payers at the cost.
This report gives insights into what US healthcare payers really think about HCV drug pricing, the growing and frighteningly undefined patient population, limited clinical/outcomes data, poor patient adherence and education - and how can industry positively help and respond.
Key Takeaways
Payer Insights: Hepatitis C, based on in-depth interviews with 12 leading healthcare payers in the US, is packed with hard-hitting, candid opinions and advice on how, from their perspective, Pharma can get it right in the future.
Gilead’s commercial success with its ground breaking HCV treatment Solvadi has been matched by the opposition of healthcare payers at the cost.
This report gives insights into what US healthcare payers really think about HCV drug pricing, the growing and frighteningly undefined patient population, limited clinical/outcomes data, poor patient adherence and education - and how can industry positively help and respond.
Key Takeaways
- Learn critical lessons when establishing pricing policies and know which approaches will be welcomed by healthcare payers
- Assess upcoming combination therapy launches from Gilead, AbbVie, Bristol-Myers Squibb and Merck & Co: how do healthcare payers view these developments in clinical and cost terms?
- Understand current HCV treatment guidelines and know the critical role they play in healthcare payer decisions
- Accommodate and negate in your product plans the mechanisms by which payers control reimbursement and access to treatment
- Understand the sometimes conflicting pressures on Medicaid/private HMOs: how could this affect contract negotiations?
- Gain competitive advantage by providing better more transparent clinical data to support your product – absolutely critical in a world where there is therapy choice
- Evaluate payer attitudes to price rebates and discounts as well as examining the challenges risk sharing and outcome based pricing could play
- Which pricing strategies could give you a competitive edge in the crowded HCV market?
- Diagnostic screening is set to increase: Is it good for patients and bad for economics, and how could it affect you?
- How could information and education programs utilising trusted and “real world” data be used to better support your clinical and outcomes claims?
- Which R&D drivers will impact the sector and introduce a new level of treatment options, and when?
- What practical and commercially beneficial role could industry play in helping patients make sure they take their medicines as directed?
- Chief Medical Officer, Integrated Health Services Organisation
- Medical Director, Managed Healthcare Company
- Medical Policy Development Specialist, Managed Care Organisation
- Senior Clinical Manager, Pharmacy Benefit Manager
- Pharmacy Director, Community Health Plan
- Executive Director, Pharmacy Services, Managed Care Organisation
- Medical Director, Multi-State Healthcare Organisation (covering Medicaid and Medicare lives)
- Medical Director, Managed Care Organisation
- Chief Medical Officer, Managed Care Organisation
- Executive Vice President, Pharmacy Benefit Manager
- Pharmacy Director, Managed Care Organisation
- Pharmacy Director, Pharmacy Benefit Manager
- Based on primary and in-depth research with senior managers and planners working daily in public/private managed care organisations across the US
- Includes candid payer opinion that can help shape your plans and modify behaviour
- Includes comprehensive background information on the HCV market, which puts the comments from payers into context
- “Someone needs to look at real world data and state what's really working, what's the most cost-effective treatment, because even for genotype 3 patients, peginterferon and ribavirin are still preferred versus adding Sovaldi, but that hasn't come across [and] everybody's just automatically adding it. You're looking at going from $20,000 with a 48 week course to $112,000, $113,000 for a 12 week course. So it's really hard to justify some of this.”
- “What's changed is not solely a function of hepatitis C. It's been influenced by specialty drugs as a whole, and the realisation that if plans didn't have a specialty tier on their drug benefit, they now should. Sovaldi, snuck up on everybody with its pricing… everybody was thinking of Sovaldi as being just a follow on to Incivek and Victrelis. While they were not inexpensive either, Sovaldi took it to another level. Most plans have put in place prior authorisation criteria that allow for its use.”
- “There's a lot of scepticism [and] disbelief or distrust with Gilead and whoever's going to come out next, depending upon what their launch looks like and what their cost is. There's a lot of frustration with the Federal Government in allowing things like this to happen. So I think the next six months are going to be really difficult for the manufacturers. If they come in 20 percent less than what Gilead did and the product is all oral or has a better safety profile, better adherence, better efficacy, I think that they will definitely easily take the market over.”
CONTENTS
EXECUTIVE SUMMARY
INTRODUCTION
METHODOLOGY AND OBJECTIVES
HEPATITIS C MARKET OVERVIEW
Hepatitis C virus (HCV)
Genotypes
Disease burden and associated costs
Current treatment landscape
Guidelines and key recommendations
Screening for HCV
Treatment guidelines
PRICING, REIMBURSEMENT AND MARKET ACCESS (PR&MA) FOR KV TREATMENTS
Reimbursement of current HCV therapies
The review process for formulary indusion of new drugs
Key influences over reimbursement decision-making
Is Medicaid reimbursement decision-making different'
Treatment attributes and reimbursement status
Current challenges and opportunities
Specific data needs to support decisions
Real word data
Biomarkers
Warehousing in HOT from a payer perspective
Future challenges and opportunities on controlling PR&MA
Patient compliance and access to therapy
Methods of monitoring patient compliance
Lifestyle issues and drug abuse
Should Medicaid be able to "carve-out" HCV drug costs?
PERSPECTIVES ON FUTURE DRUG LAUNCHES IN THE HCV MARKET
Payer awareness of new pipeline therapies and key concerns
Key combination therapies in late-stage development
Pricing expectations for new therapies
Expectations on contracting (eg outcomes based, risk sharing)
What payers won't pay for, and where they see value
Shorter therapy durations should not be at a premium
Preferred regimens may be based on cost
LONGER-TERM PERSPECTIVES ON PFT&MA IN THE US HEALTHCARE SYSTEM
The perceived impact on longer-term cost savings
Mistakes made by pharma, and key lessons to take forward
Words of advice for pharma companies
Impact of HCV on other indications and classes of products
APPENDIX
Payers interviewed for this report
Current HCV pipeline
EXECUTIVE SUMMARY
INTRODUCTION
METHODOLOGY AND OBJECTIVES
HEPATITIS C MARKET OVERVIEW
Hepatitis C virus (HCV)
Genotypes
Disease burden and associated costs
Current treatment landscape
Guidelines and key recommendations
Screening for HCV
Treatment guidelines
PRICING, REIMBURSEMENT AND MARKET ACCESS (PR&MA) FOR KV TREATMENTS
Reimbursement of current HCV therapies
The review process for formulary indusion of new drugs
Key influences over reimbursement decision-making
Is Medicaid reimbursement decision-making different'
Treatment attributes and reimbursement status
Current challenges and opportunities
Specific data needs to support decisions
Real word data
Biomarkers
Warehousing in HOT from a payer perspective
Future challenges and opportunities on controlling PR&MA
Patient compliance and access to therapy
Methods of monitoring patient compliance
Lifestyle issues and drug abuse
Should Medicaid be able to "carve-out" HCV drug costs?
PERSPECTIVES ON FUTURE DRUG LAUNCHES IN THE HCV MARKET
Payer awareness of new pipeline therapies and key concerns
Key combination therapies in late-stage development
Pricing expectations for new therapies
Expectations on contracting (eg outcomes based, risk sharing)
What payers won't pay for, and where they see value
Shorter therapy durations should not be at a premium
Preferred regimens may be based on cost
LONGER-TERM PERSPECTIVES ON PFT&MA IN THE US HEALTHCARE SYSTEM
The perceived impact on longer-term cost savings
Mistakes made by pharma, and key lessons to take forward
Words of advice for pharma companies
Impact of HCV on other indications and classes of products
APPENDIX
Payers interviewed for this report
Current HCV pipeline
