I would encourage pharma to progress beyond Patient Access Schemes to true and equitable risk-sharing schemes with payers.
Increasing financial constraints on healthcare systems mean payers need to extract the maximum value from their medicines bill. Risk-sharing is a way of increasing patient access to medicines, while protecting the healthcare system from excessive payments for treatments that prove to be less effective than anticipated.
For low volume, high-cost treatments, such as biologicals or cancer treatments, access schemes in the UK have generally been introduced to pass the cost-effectiveness threshold required by NICE. These schemes range from simple discounting, to provision of free cycles of treatment. These share costs, but do they really share the risks?
Do they provide pharma or payers with insight or data into patient outcomes and the cost effectiveness of these drugs in a real-world setting?
For the more common conditions cost-containment is often executed as a 'race to the bottom', with use of the lowest cost generic drugs. But this approach may prevent access to newer and more expensive medicines, even though there may be evidence of improved outcomes.
Take management of Type 2 diabetes as an example. Often there's uncertainty about the benefits of new, expensive drugs. If predicted outcomes can be delivered, the benefits in terms of avoided complications could be significant. But when problems of patient adherence are factored into the cost—benefit equation, reimbursement of these newer drugs carries an even higher financial risk for the payer.
Risk-sharing schemes at a local level, based on delivery of patient outcomes in long-term conditions could provide real benefits to pharma, payers and patients. Pharma will want to ensure that adherence levels are increased, and their product is correctly positioned within the care pathway in order to deliver on agreed outcomes. Payers will have reassurance that their money is being well spent with a reduction in wastage due to improved adherence. Patients will benefit from improved access to treatments, and from support for better adherence to their medication regime.
The trick will be to develop metrics that are simple to collect but which also describe relevant patient outcome measures.
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