Pharmaceutical Pricing and Reimbursement in Oncology - Payer Pressure to Justify Premium Pricing of Novel Agents, Pushing Companies to Risk-Sharing ModalitiesGBI Research
July 10, 2012
65 Pages - SKU: XGBR3958730
Additional InformationCancer Costs Call for Clever use of Capital
Healthcare systems across the globe need to find new ways to fund cancer treatments, according to a new report by healthcare experts GBI Research.
The report* shows financial issues arising from oncology therapy costs in Europe and the US. This implies that better insurance guidelines and a bigger cash injection is needed to support the gigantic patient population.
According to the World Health Organization (WHO), around 13% of all deaths in the world are due to cancer. Principal oncology treatments include surgery, radiation therapy and chemotherapy, with multiple modalities often used. Surgery represents the oldest form of effective cancer therapy, while the approval of new molecularly targeted anti-cancer drugs represents an exciting new advancement in clinical oncology. These drugs offer benefits which include reduced toxicity, improvement in survival, pain reduction, and overall improvement in quality of life.
Access to treatment is controlled by government policies, which are often influenced by economic limitations, and these new anti-cancer drugs unfortunately come with a heavy price tag. Combination therapies are already leading the overall cost of drug therapy to increase over time, creating difficulties for payers who struggle to afford treatment costs. Therefore the usage of groundbreaking anti-cancer drugs differs dramatically between countries, as less effective treatment options can be provided at far lower costs.
The Agenzia Italiana del Farmaco (AIFA) – the Italian Medicines Agency – published a list of drugs for diseases approved for reimbursement in November 2010, and oncology therapeutics were conspicuous in their absence. The exclusion of oncology drugs was partly due to high therapeutic costs, which would place regional healthcare authorities in significant debt.
European countries are managing the influx of new therapies in oncology through innovative strategies. Higher levels of performance are now demanded from oncology treatments in terms of survival and remission, in order for the drug to qualify for reimbursement, as insurance bodies now scrutinize the benefits derived from therapies more rigorously than before. The AIFA developed a health technology assessment (HTA) system for anti-cancer drugs, to manage the delivery and funding of novel and expensive drugs. Other European countries are adopting similar conditional reimbursement agreements, and in light of new upcoming anti-cancer drugs, it can be expected that the examination of benefits will become even more rigorous, as payers must allocate their budgets more prudently.
Insurers across the US are being forced to cover costs for high performing chemotherapy treatments, with various states now enacting cancer drug parity laws to protect patients from financial hardships. Previously, in cases where no intravenous substitute for oral chemotherapy drugs was available, cancer patients were forced to bear the entire financial burden, but hefty out-of-pocket costs led to a patient outcry for help.
This law represents a positive step, but it is not yet maintained among all US states, and it remains a global uncertainty whether costs will be covered for cancer sufferers in the future.
*Pharmaceutical Pricing and Reimbursement in Oncology - Payer Pressure to Justify Premium Pricing of Novel Agents, Pushing Companies to Risk-Sharing Modalities
This report is provides a comprehensive overview of the healthcare system, and the pricing and reimbursement processes in the top seven countries of the world, with detailed analysis of the different regulatory mechanisms used in these countries. The report closely scrutinizes the major pharmaceutical changes and oncology-related pricing and reimbursement in these countries in the recent past and their impact in the near future. The countries analyzed in the report are the US, the top five European countries of the UK, France, Italy, Germany and Spain; and Japan.
This report is built using data and information sourced from proprietary databases, primary and secondary research and in-house analysis by GBI Research’s team of industry experts.
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