Thoughtleader: Thomas Nagle, Monitor Group

May 01, 2007
By Pharmaceutical Executive Editors

Tom Nagle
Over the past 20 years, drug companies went from having carte blanche to set drug prices to operating in an ever more tightly controlled environment. Instead of doctors calling the shots, government and private payers are becoming increasingly vocal about which drugs they will and will not cover. Frustrated patients, in turn, are getting anxious about their out-of-pocket costs and access to the medicines they need.

This is the volatile environment that pharma is operating in—and smart companies need to wake up to the new reality, says Tom Nagle, founder of consulting firm Strategic Pricing Group (now a member of Monitor Group) and co-author of The Strategy and Tactics of Pricing. Nagle believes the US goverment will soon follow Europe's lead in taking a greater hand in price negotiations, and pharma will need to be able to communicate the value that products offer. Here he discusses how pharma can meet that challenge.

How have pricing issues changed since you published the first edition of your book?

Until the 1990s in Europe and until only recently in America, the pharmaceutical industry lived in a world of its own. It did not operate in a normal market; it was a market where the person making the purchasing decision was neither the person consuming the product nor the person paying for it. It was a crazy world.

It also wasn't a normal market that was driven by value. And that's what's changed. It has definitely changed in Europe, and it's changing in America. Good pricing was all about setting an optimal price level given what customers were willing to pay. And that willingness to pay was almost unrelated to the drug. It was very much related to things like how frequently companies could detail prescribers.

Government cost-containment measures have generated more than $25 billion over three years in the top-five EU countries
Those days are rapidly going away because now we're in a situation where you have payers very systematically making these buying decisions. There are only a few products prescribed by a few specialists where decisions are made independently. Instead, buying decisions are driven by a comprehensive understanding of value that goes beyond just the value for a particular patient to the impact of that drug on large numbers of people.

What changed?

Ten years ago, companies were in a situation where better anti-infectives were curing patients who otherwise might have died, new gastrointestinals were reducing the number of ulcer operations, and the first statins were preventing countless heart attacks. The value of these drugs was so great that worrying about what companies were paid just wasn't that important. People were more concerned about the benefits they were getting.

But we're now at the point where we're making more incremental improvements and looking at smaller and smaller patient populations. And these drugs cost immensely more than those early statins and those gastrointestinals and those anti-infectives.

So we're in a situation where companies have to justify value, and that creates a normal market for the pharmaceutical industry. You know, I hear people all the time saying, "We're going into this crazy world." Well, no, you're not going into a crazy world. You were in a crazy world. You're going into a normal world. Good pricing used to be about setting the optimal price, given what people were willing to pay. Now pricing has become a lot more complicated because good pricing is about getting paid for the value you create.

Europe is fascinating to watch. Could what's happening there—reference pricing in Germany, for example—happen in the United States?

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