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A key issue for biopharma marketers today is balancing cost and value factors around specialty biologic drugs, particularly those for cancer and other high profile, life-altering diseases.
A key issue for biopharma marketers today is balancing cost and value factors around specialty biologic drugs, particularly those for cancer and other high profile, life-altering diseases. The financial and reputational stakes for players in this hotly contested commercial space are high, compounded by a startling lack of awareness of the incentives that drive specific actions by payers, providers, health professionals, drug manufacturers – and, ultimately, the patient. Bridging this perception gap was the theme of Pharm Exec sister organization CBI’s annual conference on Access and Reimbursement, held in Philadelphia last week. Speaker after speaker noted that pharmacy spend is now the fastest growing cost segment for insurers, and specialty drugs are the principal factor.
A highlight of the meeting was release of a survey by a new community-based practitioner network, The Health Payer Council (view the results here), examining how US payers are responding to access and financing challenges for specialty medicines. The Council conducted interviews with 52 US-based medical and pharmacy directors – whose decisions affect 60 million commercial policy lives – earlier this month. The objective was to identify what payers are doing at present to manage pharmaceutical costs and to assess cost control measures that are likely to be applied over the next three years, particularly in the oncology space.
Here are three key findings:
Roger Green, an industry veteran and consultant who conceived and administers the Health Payer Council, tells Pharm Exec the survey evidences a “disconnect” between what payers are doing now to manage high drug costs in specialty and strategies that are not being applied – despite the perception that these are the ones most likely to be successful. “Payers by and large are still fixated on a philosophy that relies on the incentive of the carrot or the stick. This is not the optimal way to accomplish what is necessary to facilitate change, which is getting the various silo’d parts of the system to cooperate, share and work in partnership. More emphasis must be placed on changing basic behaviors.” At root, Green says, is a lack of awareness. “It’s simple. No one in the system understands how anyone else makes money.”
The Council, which now has 107 members drawn from the medical director and pharmacy payer community, has a mandate to do just that. It won’t make policy but is to serve as a forum to exchange information and build dialogue, with big Pharma a principal focus. You might call it a Venn diagram of the payer community, writ real.