The Year Payers Stopped Threatening - Pharmaceutical Executive

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The Year Payers Stopped Threatening
The notion that employers would continue to pay the cost, whatever it was, has been turned on its ear.


Pharmaceutical Executive


However, some payers note they have seen a clear relationship between the quality and quantity of pharmacoeconomic data that is presented in a dossier, and the number of branded therapeutics already on the market in that disease area. These payers indicate they see both better pharmacoeconomic data, and more of it, for new therapeutics arriving in the most competitive markets. To them, this means manufacturers have the ability to fully comply with payer needs, but do so only when it suits their purposes. On the other hand, it also means that manufacturers are not taking advantage of the opportunity to pull far ahead of future competition by providing clearly defined advantages for those products in less crowded markets. Though the risk of revealing or measuring too much might seem great, that approach is short sighted. By setting the bar and obtaining a solid market footing based on concrete arguments, one can gain a long-term defensible position.

Trust (and coverage) is in the details. Almost all payers voiced frustration with the transparency of pharmacoeconomic information they receive from manufacturers. They note companies typically submit pharmacoeconomic models in formulary dossiers in a non-dynamic format, making it difficult to meaningfully assess the model. One payer said, "There is a world of difference between receiving a model presented in an electronic spreadsheet that you can play with and evaluate, and receiving hardcopy output of that model." Another MCO executive relayed a situation in which the MCO went back to a manufacturer to request an electronic version of a pharmacoeconomic model that was presented, and they received, after a lengthy delay, a PDF file. When the MCO pressed the manufacturer for compliance with the request, the MCO was told the electronic model is considered proprietary information and could not be shared.

The result of this kind of heavy-handed action by manufacturers is that most payers believe they can't rely on the models companies submit. MCOs say this leaves them with little choice but to produce their own models and economic impact assessments, from which they make formulary decisions. Pharma manufacturers should be greatly troubled by this. These credibility issues limit manufacturers' abilities to make sure their best arguments are properly considered and limit their ability to proactively influence payer decision makers.

Customer rights. Payers feel their requests are not being answered and are thus resorting to the radicalized approach outlined in this article. Placed in almost any other context, no one would ever expect this kind of behavior from a seller toward a customer—refusal to fulfill customer requests typically would mean a lost sale. To that end, the general tone of the relationship between manufacturers and payers is shifting. The payers are claiming the role of customer with the rights to:
  • insist on information
  • decide what they will purchase to fill a need
  • decide the context within which a product can be utilized.

The overall concern here is that manufacturers are thinking almost exclusively of how to compete against other brands, ignoring the need to satisfy their customers in the absolute. The result is a marketing-driven focus on marginal one-up smanship, rather than a broad sales view, encompassing the needs of the holders of the purse strings.

Cooperation, Hindered by the Past Many of the OBA changes that were publicly and privately predicted by the Bruckner Group and published in Pharm Exec in the last five years are now reality. So where does that leave payers and manufacturers?

By and large, many payers believe that companies need to do a much better job of developing and bringing to market pharmaceuticals that offer better value. Although this has been the mantra of the payer community for the last several years, MCOs understand that the lengthy development time for therapeutics makes it difficult for manufacturers to simply comply overnight. However, there is also a feeling that manufacturers are frequently failing to make a real effort at addressing payers' needs. Some even believe that cooperation is not even on the horizon.


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