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Pharma–payer partnerships – rhetoric or reality?

Pharma needs to embrace value-add initiatives in order to forge successful partnerships with payers

Successful pharma–payer partnerships require a change in the mindset of participants from their current comfort zones – payers from a fixed focus on purely budgetary matters and pharma from providing medicines on a volume based, benefits selling basis.  

A consideration of the complete patient treatment journey requires fresh thinking from both stakeholders. External factors, such as a realisation by pharma that the era of the blockbuster is over, an increased patient empowerment fuelled by the Internet and the current austerity measures sweeping Western Europe, are accelerating the need for mutually beneficial partnerships.

Recently in the UK, the Health and Social Care Act provided a framework to promote joint working between the NHS and the pharmaceutical industry. Its aim is to improve the innovation and delivery of healthcare through improved collaboration between the two parties. At a European level, the Innovative Medicines Initiative (IMI), a public private partnership between the EU and EFPIA (European Federation of Pharma Industries & Associations), has a budget of €2bn to support joint projects in areas such as safety, education and training. This initiative includes not only payers and industry but crucially patient organisations, academia, regulatory agencies and other industry partners (eg, IT/technology).

Clearly, there is significant movement from the payer side to embrace industry but is the industry ready to respond? The pharma industry is a typically conservative, highly regulated vertical that responds to regulatory bodies (FDA/EMA) but is rarely proactive or an initiator of change in its business vertical.

So what are payers looking for? What are their needs? Pharma has categorised its needs under the term the 'fourth hurdle', which typifies its attitude to payers as barriers to prescribing. 

These 'needs' cover three areas: a demonstration of real-world value of medicines; assistance with budgets and participation in non-zero sum game partnerships. 

Payer partnerships fall into two categories: price and reimbursement (risk-sharing agreements/patient access schemes) and value add (provision of services beyond the pill). Patient Access schemes have been around for several years (in the UK the first being instituted in 2002 for MS drugs) but have their critics and are perceived as being of more value to the industry than to payers (Raftery J, BMJ 2010;340:c1672 'Multiple Sclerosis Risk-sharing scheme: A Costly Failure').

Challenging times lie ahead but I believe we will see the emergence of quality value-add partnerships …

Trust is not commonly associated with the pharma industry and it tends to be described in the same category as the tobacco and oil industries. Recent publications such as Ben Goldacre's Bad Pharma (Ben Goldacre, Bad Pharma, Fourth Estate, 2012) help reinforce this image. 

For partnerships to work, participants will need to move out of their comfort zones – and pharma will need to embrace more value add forms of partnerships. These forms of partnerships will be quite challenging and will question the lengths pharma will go to beyond just being a pill provider.

The recent introduction of novel oral anticoagulants (NOAC) as a class of medicines is a case in point. The class is likely to replace the current standard of care (warfarin) which has been around for over 50 years. Despite being considered a 'dirty' drug warfarin has spawned the development of complex blood monitoring clinics and associated medical and administrative staffing. Value-add partnerships here will need to address the consequences of the closure of these clinics and associated service redesign issues that payers will have to address.

Challenging times lie ahead but I believe we will see the emergence of quality value-add partnerships that are mutually beneficial and ultimately improve patient quality of life.

Article by
Pascal King

global director at the Access Partnership, a global market access and consultancy agency

8th March 2013

From: Sales


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