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Payer Perspectives on Risk Sharing Deals

Payer Perspectives on Risk Sharing Deals

Introduction

Risk sharing agreements have been a strategic tool employed for more than a decade. Yet, they’re still widely misunderstood — and underutilized, especially as they may help provide access to a frugal, risk-averse marketplace.

Are you up to speed on all that a risk sharing agreement might do for your product or organization?

Payer Perspectives on Risk Sharing offers expert insights on how risk sharing agreements can be a win-win for both pharmaceutical companies and payers in helping to build relationships and achieve optimal market access. In addition, gain perspective on when and how the right risk sharing agreement can help your product succeed in the marketplace.

Reasons to Purchase

Key Benefits

  • Critical insights from US and EU payers and market access experts
  • Learn about the various types of risk sharing agreements
  • Understand what payers want from risk sharing agreements
  • Assess how risk sharing agreements impact market access and price
  • Determine when it makes sense for a company to propose a risk sharing agreement
  • Master how to build a risk sharing agreement that will work for you
Answers to Critical Questions

Filled with charts and up-to-the-minute survey analysis, this report offers:
  • What are the advantages and disadvantages of risk sharing agreements for companies?
  • What do payers see as the advantages and disadvantages of risk sharing agreements?
  • How might a risk sharing agreement help your product succeed in today’s marketplace?
  • What will a payer want from you in a risk sharing agreement?
  • How much “risk” is actually shared in a risk sharing agreement?
  • What support do payers offer companies considering risk sharing schemes?
Top Takeaways
  • Insights into the viability of risk sharing agreements in the US and EU5
  • A wide-ranging review and analysis of the available literature and media coverage of risk sharing agreements
  • In-depth interviews with both payers and the experts who are shaping their views on risk sharing agreements
  • Structure and anatomy of various types of risk sharing agreements
  • The pros and cons of risk sharing agreements for both companies and payers
Experts Interviewed
  • Officer for Pharmaceutical Policy, Italian Medicines Agency (Agenzia Italiana del Farmaco; AIFA), Italy
  • Pharmacy Director of a Prescription Benefit Management subsidiary of a major US health care company
  • External advisor to the Transparency Commission and Guidelines Committee in France
  • Expert from Osteba (Basque Office for HTA), Spain
  • Professor from Andalusian School of Public Health, Spain
  • Pharmacy Lead, Specialised Services, NHS England, England
  • Medical Director of a US integrated health services organisation
  • Programme Director Technology Appraisals, Highly Specialised Technologies and the Patient Access Schemes Liaison Unit at the National Institute for Health and Care Excellence (NICE), England
  • Pharmacy Director of US Managed Care Organisation (1)
  • Pharmacy Director of US Managed Care Organisation (2)
  • Health Economist, A Gemelli Teaching Hospital, Italy
  • Health Economist, France
About FirstWord Reports

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1.Executive Summary
2.Research objectives and methodology
3.Setting the scene
3.1.Key findings
3.2.Austerity remains a watchword for payers
3.3.Rising cost of new medicines and uncertainty in their real value
3.4.Protecting list prices
3.5.Rise in Health Technology Assessment and the rise in risk sharing
3.6.Matching the increasing flexibility from the European regulator in 2015
3.7.Risk sharing schemes can provide a ‘third way’ to provide patient access
4.Risk sharing schemes in the 2000s and 2010s – managed access by another name
4.1.Key findings
4.2.The many names for risk sharing schemes
4.3.Increasing popularity of schemes but still a niche
4.4.Cancer focus
4.5.Different risks, different schemes
4.6.Learning by doing: past experience can guide choice of scheme in
5.Risk sharing schemes are an important part of the market access jigsaw in Europe and the US in 2015
5.1.Key findings
5.2.France – limited use of performance-based risk sharing, widespread use of financial-based risk sharing
5.2.1.A handful of examples of performance-based risk sharing
5.2.2.Risk sharing in France is shorthand for performance-based schemes
5.2.3.Performance-based risk sharing schemes are not a substitute for poor clinicaldevelopment
5.2.4.Performance-based risk sharing schemes can be explored early by companies
5.2.5.Companies should take a tailored approach to deciding on outcomes and data needed for schemes
5.2.6.Offering a performance-based risk sharing scheme is a strategic choice and comes with risk for the manufacturer
5.3.Germany – not open to risk sharing schemes
5.4.Italy – a trail blazer for risk sharing schemes
5.4.1.More schemes than any other country
5.4.2.Risk sharing is just one of three types of schemes in Italy
5.4.3.A shift towards performance-based schemes but AIFA is focused on what makes sense in context
5.4.4.AIFA is driving the adoption of schemes
5.4.5.Schemes provide access that would not otherwise be available, but with the risk of lower prices and paybacks in future
5.5.Spain – a patchwork of national and regional schemes
5.5.1.Limited number of national schemes, and the regions are leading the way
5.5.2.Payers want schemes that are performance related
5.5.3..Companies should engage early when thinking about developing a risk sharing scheme
5.5.4.Outcomes and data should reflect the context and make use of existing infrastructure, where it is available
5.5.5.Companies can take up opportunities to work with Health Technology Assessment Agencies to develop schemes
5.5.6.Improve access with schemes, without necessarily reducing your price
5.6.UK – from complex schemes to simple schemes
5.6.1.A pioneer in risk sharing since 2002
5.6.2.From risk sharing to Patient Access Schemes
5.6.3.Emphasis on simple schemes
5.6.4.Outcome-based schemes may come in the future
5.6.5.Engage early with the NHS
5.6.6.What data do payers want to support risk sharing schemes?
5.6.7.Simple schemes mitigate against the need to collect data
5.6.8.Just ask for help if you are thinking of putting forward a scheme
5.6.9.Protection of list price whilst securing access
5.7.US – early experimentation and renewed interest in 2015
5.7.1.Public and private payers have adopted risk sharing schemes in the past
5.7.2.Payers are concerned that the only winners from risk sharing schemes are the manufacturers
5.7.3.Payers want ‘true’ risk sharing schemes
5.7.4.More proposals for schemes are expected by payers
5.7.5.Companies will have to keep their proposals for schemes simple if they want Payers to seriously consider them
5.7.6.Engage early
5.7.7.Measure outcomes that matter in context, and explore guaranteeing your product can avoid costly care
5.7.8.Potential to improve
6.Conclusions

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