Pharma and Payers – Building Better Relationships
Changes in the healthcare landscape have put payers (public and private) under mounting pressure to reduce the cost of care, and given them much greater influence over market access to new medicines.
In this new environment, regulatory approval of new drugs no longer guarantees favourable pricing and formulary placement. Instead, payers focus increasingly on value to determine pricing and access.
Drug developers need to understand the value review process, and adapt their organisation to engaging payers early in the journey. More profoundly, pharma companies must find ways to evolve their current transactional, and even adversarial, relationships with payers to more collaborative ones. After all, Pharma and payers share the same ultimate goals – to lower costs and improve care.
This new report helps Pharma and payers build a “win-win” relationship; by understanding each other’s needs, and by exploring new opportunities for collaboration.
Report Overview
This extensive report includes a wealth of information and tools that empower Pharma and payers to work together more effectively, with the ultimate goal of offering patients access to life-saving drugs, biologics, and vaccines.
After painting a detailed picture of the current environment (including explaining regional payer systems, and key factors driving change), the report offers a fascinating exploration of “what payers want”. You’ll learn about the primary ways in which payers are measuring outcomes (e.g., QALY, CER, pragmatic clinical trials), and discover best practices in resource allocation, organisation, communication, and accountability.
The report includes real case studies of successful pharma-payer partnerships (such as risk-sharing agreements, clinical outcomes studies), and draws on expert opinions and advice from more than a dozen of the world’s foremost thought leaders and executives in this space.
Key Report Features
“It is no longer simply about drug cost but total cost of care to demonstrate a product’s value. Pharma is beginning to understand that.” Dr. Marcus Wilson, vice president, WellPoint, HealthCore Inc
“If drugmakers haven’t got the relevant health economic data together to support the price of a new drug then it’s never going to float.” Michael Morgan-Curran, director, mHealth Diabetes, GSMA; director/owner, MM-C Innovative Solutions
“Each payer is different and to create and maintain long term mutually beneficial relationships, pharmaceutical companies must understand a payer’s environment, the way they work, their needs and drivers.” Elliot Rosen, managing director, Accession Healthcare Consultancy
In this new environment, regulatory approval of new drugs no longer guarantees favourable pricing and formulary placement. Instead, payers focus increasingly on value to determine pricing and access.
Drug developers need to understand the value review process, and adapt their organisation to engaging payers early in the journey. More profoundly, pharma companies must find ways to evolve their current transactional, and even adversarial, relationships with payers to more collaborative ones. After all, Pharma and payers share the same ultimate goals – to lower costs and improve care.
This new report helps Pharma and payers build a “win-win” relationship; by understanding each other’s needs, and by exploring new opportunities for collaboration.
Report Overview
This extensive report includes a wealth of information and tools that empower Pharma and payers to work together more effectively, with the ultimate goal of offering patients access to life-saving drugs, biologics, and vaccines.
After painting a detailed picture of the current environment (including explaining regional payer systems, and key factors driving change), the report offers a fascinating exploration of “what payers want”. You’ll learn about the primary ways in which payers are measuring outcomes (e.g., QALY, CER, pragmatic clinical trials), and discover best practices in resource allocation, organisation, communication, and accountability.
The report includes real case studies of successful pharma-payer partnerships (such as risk-sharing agreements, clinical outcomes studies), and draws on expert opinions and advice from more than a dozen of the world’s foremost thought leaders and executives in this space.
Key Report Features
- Detailed insights into what payers want from Pharma (and vice versa)
- Recent case studies of collaborations between major pharma companies and payers
- Practical advice on meeting payers’ needs and tackling potential problems
- Review of the growing influence of patients/consumers
- Description of different types of payers
- Guide to the payer frameworks in key markets (US, UK, and the leading European pharma markets: Germany, France)
- Learn from successful collaborations between payers and Pharma
- Understand what payers expect and want from Pharma
- Improve Pharma-payer communications
- Optimise your organisational structure to meet payer needs
- Be aware of potential pitfalls
- Generate successful drug pricing and formulary placement discussions
- Be ready for future developments
- Steve Phillips, director, Health Policy and Reimbursement, Johnson and Johnson — government health policy leader and advisor to all J&J operating companies
- Tehseen Salimi, vice president, Customer Medical Synergies, Sanofi-Aventis — payer interaction leader, scheduled to speak at Evidence Based Reimbursement Summit 2012
- Dr. Marcus Wilson, vice president, WellPoint, HealthCore Inc — pioneer in real-world outcomes research
- Terri Bernacchi, managed care pharmacist/consultant, engaged with several US health plans and IMS Health Managed Market Services — expert and author on payer engagement
- Michael Hurwich, president, Strategic Pricing Management Group — one of the world’s foremost pricing, revenue & strategy management consultants
- Cyndy Nayer, president and founder, Center of Health Value Innovation (CHVI) — thought leader on value-based benefit design
- And many more renowned thought leaders and senior industry executives.
“It is no longer simply about drug cost but total cost of care to demonstrate a product’s value. Pharma is beginning to understand that.” Dr. Marcus Wilson, vice president, WellPoint, HealthCore Inc
“If drugmakers haven’t got the relevant health economic data together to support the price of a new drug then it’s never going to float.” Michael Morgan-Curran, director, mHealth Diabetes, GSMA; director/owner, MM-C Innovative Solutions
“Each payer is different and to create and maintain long term mutually beneficial relationships, pharmaceutical companies must understand a payer’s environment, the way they work, their needs and drivers.” Elliot Rosen, managing director, Accession Healthcare Consultancy
EXECUTIVE SUMMARY
INTRODUCTION
Payers: who’s who
US payers
European payers
Payer organisations in the UK (England and Wales)
Scotland
France
Germany
CHANGING LANDSCAPE
Rapid growth of high-priced biologics and specialty drugs
A shift from volume-driven contracts to value-based pricing
Patient non-adherence: a costly problem
Payers demand real-world data
Health economic data: is it good enough for payers?
Patient power
THE DRUG MANUFACTURER CONUNDRUM
THE CHANGING DRUG MANUFACTURER-PAYER RELATIONSHIP
WHAT PAYERS WANT
Measuring health outcomes
QALY and ICER
Comparative effectiveness research, pragmatic clinical trials and adoptive licensing agreements
Improving market access via adaptive licensing
Market access agreements: health outcomes and risk-sharing schemes
Innovative US drug manufacturer-payer alliances and partnerships
Building better relationships
THE NEW DRUGMAKER-PAYER RELATIONSHIP
HTA and value-based pricing are here to stay
CER is becoming the new normal
Quality of economic modelling and health outcomes data is vital
Cost of a drug vs cost of care
Best-price frameworks
When to approach payers
Moving From transaction to collaboration builds trust
Sharing and exchanging patient data
OPENING NEW COMMUNICATION CHANNELS IS ESSENTIAL
Create an environment of accountability
MOVING FORWARD TOGETHER
CONCLUSIONS
INTRODUCTION
Payers: who’s who
US payers
European payers
Payer organisations in the UK (England and Wales)
Scotland
France
Germany
CHANGING LANDSCAPE
Rapid growth of high-priced biologics and specialty drugs
A shift from volume-driven contracts to value-based pricing
Patient non-adherence: a costly problem
Payers demand real-world data
Health economic data: is it good enough for payers?
Patient power
THE DRUG MANUFACTURER CONUNDRUM
THE CHANGING DRUG MANUFACTURER-PAYER RELATIONSHIP
WHAT PAYERS WANT
Measuring health outcomes
QALY and ICER
Comparative effectiveness research, pragmatic clinical trials and adoptive licensing agreements
Improving market access via adaptive licensing
Market access agreements: health outcomes and risk-sharing schemes
Innovative US drug manufacturer-payer alliances and partnerships
Building better relationships
THE NEW DRUGMAKER-PAYER RELATIONSHIP
HTA and value-based pricing are here to stay
CER is becoming the new normal
Quality of economic modelling and health outcomes data is vital
Cost of a drug vs cost of care
Best-price frameworks
When to approach payers
Moving From transaction to collaboration builds trust
Sharing and exchanging patient data
OPENING NEW COMMUNICATION CHANNELS IS ESSENTIAL
Create an environment of accountability
MOVING FORWARD TOGETHER
CONCLUSIONS
