Payer Agreements: Splitting the Risk

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Payer Agreements Splitting the RiskMarket
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Payer Agreements Splitting the Risk

• Budgets are tight. Payer funding for new products
  is dwindling. And for pharmaceutical companies,
  market access is more and more difficult to
  attain.Across the UK, the US, Canada, Australia
  and parts of Europe, payer schemes are
  increasingly de rigueur. Schemes advanced by
  pharmaceutical companies either aim to grapple
  financial issues such as price volume agreements,
  or they tackle uncertainty by addressing
  increased data collection.
• Report OverviewIn Payer Agreements Splitting
  the Risk, FirstWord Dossier offers a complete and
  concise overview of payer schemes by definition
  and category. Based on an array of expert
  interviews, the report discusses the key drivers
  behind the evolution of payer schemes from
  financial imperatives to market uncertainty. Most
  importantly, the report defines-country by
  country-emerging trends based on current case
  studies and tackles the big question What are
  the key features that will ensure success?
• Key featuresDetailed examination of the role
  of agreements in global pricing, reimbursement
  and market accessDiscussion of the drivers for
  schemes, including HTA and financial
  challengesCountry-by-country trends illustrated
  with case studiesExpert insight into the role
  of schemes and their evolutionAnalysis of the
  pros and cons of agreements
• Key BenefitsDefinitions and categories of
  schemesExpert insight from key regulatory
  bodiesComprehensive references to key literature

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• Key Questions AskedWhat principles should be
  used in designing schemes?When should companies
  offer risk-sharing agreements?How can European
  risk-sharing be implemented in the US?What is
  the current state of play with schemes
  globallyWhat changes are likely in the future?
• Who Should Read This ReportMarket access
  directors and managersHealth economics
  professionalsHealth economics
  professionalsHealth Outcomes / Outcomes
  Research professionalsPricing and Reimbursement
  teamsGovernment and regulatory affairs
  analystsMarketing research/business
  intelligence managersGovernment and regulatory
  affairs analyst
• Key quotes'The current international
  pharmaceutical pricing framework is far too
  rigid. Manufacturers willing to openly
  differentiate the price for a given product in
  line with the different ability of various payers
  to afford a product will be punished by the
  consequences of international price referencing.
  At the same time, price systems are barely
  capable of differentiating the price for a single
  product that is used in multiple indications
  according to its different value propositions.'
  Ansgar Hebborn, Global Head, Payer and HTA
  Programme Policy, Roche

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Imagine in a time where those schemes could
be really connected to one server. Like right at
the patient's bed people would enter the data and
so you would constantly be able to adjust and see
performance and see small performance even in
changes of dosing or changes or things. I know
it's very difficult but I think eventually we
might get there.' Ulf Staginnus, Head of
Pricing Health Economics Europe, Novartis and
author of www.healtheconomicsblog.com'There is
a lot of difference in the governance across
Europe, which ultimately leads to quality of HTA.
An important aspect is of course the independence
of the assessment from the appraisal and
ultimately the decision on a certain price.
That's very, very different country by country
and region by region.' Ansgar Hebborn, Global
Head, Payer and HTA Programme Policy,
RocheExpert ViewsAlicia Granados MD. Senior
Director Global HTA Strategy, GMA GenzymeAndrea
Rappagliosi Vice President European Government
Affairs Head of Brussels Office,
GlaxoSmithKlineAndrew Hobbs Managing Director,
Pope Woodhead and Associates LimitedAnsgar
Hebborn Global Head, Payer and HTA Programme
Policy, RocheClare McGrath Senior Director HTA
Policy, PfizerDavid Grainger Global Public
Policy Director, LillyGünter Harms Market
Access Public Affairs Director, Shire Human
Genetic TherapiesKalipso Chalkidou Director of
International Division, National Institute for
Health and Clinical ExcellenceKaren Facey
Evidence based health policy consultant and
non-executive Director at NHS Forth Valley, and
Chair of the HTAi Interest Group for
Patient/Citizen Involvement in HTALarry Gorkin
President, Gorkin and Cheddar ConsultingMel
Walker Senior Director Value Expert Engagement
Collaborations, GlaxoSmithKlineRobert Nauman
Principal, BioPharma AdvisorsUlf Staginnus
Head of Pricing Health Economics Europe,
Novartis and author of www.healtheconomicsblog.com
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• UK Multiple Sclerosis Risk Sharing
  Scheme Velcade money back guarantee Lucentis
  dose capping scheme US Proscar refund
  scheme Zocor refund scheme Januvia guarantee
  scheme Sanofi and Proctor Gamble pay for
  fractures scheme  Potentials and pitfalls of
  agreements Fit with pricing and reimbursement
  environments Pros and cons Reality
  check  Conclusions Too early to say Maybe
  necessary, but not sufficient Exploring
  uncertainty, not discounting in the
  future  Acknowledgements

•   Executive summary Current agreements
  with payers across Australia, Europe, Canada and
  the  US Introduction Defining and categorizing
  schemes Definitions from the literature UK
  definition and categorization Drivers for
  schemes Financial challenges HTA and saying
  ?no? Dealing with uncertainty  Country trends
  in schemes and selected case studies
  Australia Bosentan patient registry Canada Cloz
  aril money-back guarantee Denmark No cure, no
  pay for Diovan France Risperdal
  refund Germany Aclasta refund
  scheme Italy Tarceva discount scheme Sutent
  discount scheme Serbia Avastin, Erbitux and
  MabCampath rebate schemes Sweden Crestor and
  ezetimibe coverage with evidence development

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