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Payers are
negotiating reimbursement contracts based on patient outcomes
An
increase in ability to measure real-world
patient outcomes based on data from patient registries,
strengthens the position of the payer when negotiating reimbursement contracts with
pharma companies. If the
patient outcome of treatment with a particular prescription drug does not prove
to be significantly better than cheaper competing drugs, then the utility of
the drug is no better than the alternative cheaper drug. The pharma company is
therefore unlikely to receive higher reimbursements on their drug, even though
the efficacy data came out superior in clinical trials.
Pharma companies
are entering risk-sharing agreements in order to achieve higher reimbursement
If the
pharma company is confident that the patient outcomes in clinical trials can be
achieved in real-world, the company can negotiate a higher reimbursement price
by engaging in a risk-sharing agreement with the payer. Pharma
companies enter risk-sharing agreements
in order to get a higher reimbursement on new (and more expensive)
drugs. It is the case where the Pharma company takes on part of the responsibility
for patients’ compliance to treatment – this is in order to achieve a certain
patient outcome in real-world. Risk-sharing
agreements are based on a "guaranteed" outcome resulting from the
treatment, be that based on financial or outcome/performance criteria. If the
outcome is achieved the payer will pay; if not, the pharmaceutical company
refunds the payer for the cost of the drug.
Integrated
care program offering services and support ‘beyond the pill’ to increase
compliance
In
order to secure the agreed patient outcome, pharma companies’ offer integrated care programs to increase
patients’ compliance to treatment. The integrated care program offers services
and support ‘beyond the pill’. It can be anything from a wearable reminding you
to take your daily dose and information about side effects to home-delivery of
your drugs and direct access to your physician and nurses at a call centre. Strict regulations inhibit pharma companies in
communicating directly with patients. Nor do pharma companies have any
experience in including nurses at a call centre in their business model.
The need to provide this service and the lack of
capability or permission do so has allowed fast-moving-consumer-goods companies
(FMCG) in entering the market. FMCG have
entered the market offering nurse call-services reaching out to patients to
increase compliance to treatment and at the same time helping pharma companies
achieve the agreed patient outcome.
Capturing and responding to patient data will continue to drive
change
FMCG companies have
valuable experience in developing products and communicating to the
end-consumer. This is likely to influence the FMCG companies’ agility to
respond to consumer-needs. The
example of nurse call-services further results in a new touch point between the
patient and a healthcare professional. This enables the opportunity for better
patient education as well as the opportunity for capturing more patient
insights.
So far
UCB is the only pharma company who has engaged in a risk-sharing agreement with
payer. Of FMCG companies, Procter & Gamble, Walmart and Nestle have entered
the pharmaceutical industry providing healthcare services.
Despite
the fact that FMCG companies will have to comply to the same regulations as any
other healthcare provider when dealing with patients, data security is a
challenge.
For
risk-sharing agreements to be made, real-world patient data must be available
through patient registries. These patient registries are far from a reality in
most countries. When this happens, the concept of risk-sharing agreements is
likely to become a more common form of contract between pharma companies and
health insurance providers. This will in turn result in a higher need for
health services and thus increase the opportunity for new entrants like FMCG
companies on the market. In the
future, integrated care platforms will become a significant source of data for
the HCP, health insurance providers, the pharma company and the FMCG companies,
and how to deal with all this data is still left unanswered.
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Mette
Drabæk is an Associate Consultant at Blue Latitude. She believes that digital
marketing is the solution for pharmaceutical firms in becoming more
patient-centric and is very excited about the change happening in the industry
at the moment.
What will be the Top 7 Trends in Pharma
Marketing for 2015?
Read
our blog post here
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