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Pricing and Reimbursement in Oncology -- Payer views

Introduction

As payer and stakeholder anger mounts, when will the oncology drug price bubble burst?

Global cancer drug prices have increased by 10% every year between 1995 and 2013. That level of price inflation is not sustainable or winning pharma any friends. In this expert report, US and EU payers note that monopolistic pricing for novel products that represent the only therapeutic option, or the high prices demanded for treatments with minimal therapeutic benefits, cannot always be afforded or justified. Moderate payers are looking to pharma to act, less moderate payers want government intervention and price controls. Pharma risks killing the goose that laid the golden egg and payers warn it's time to get real about cancer drug pricing if pharma wants widespread reimbursement and market access.

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Why this report is important to you

What the report will enable you to do

Full report contents

Why this report is important to you

Oncological care is an area that has seen some of the steepest spending increases in the past two decades. In 2017, annual spending on anti-cancer drugs was approximately $100 billion globally, but this figure is predicted to rise to $150 billion by 2020. Some price rises have been triggered by the advent of a more sophisticated understanding of the pathophysiology of cancer, and more effective treatments mean that patients are often living longer and therefore spending on costly therapies puts pressure on the public and private purses. Payers recognise that some high-cost high-technology drugs provide profound patient improvement and, in the wider context of alternative interventions, make commercial sense. But therapies of minimal value, or products priced for rare cancers and then extended to common cancers, are facing mounting resistance. Pharma can no longer hide behind the claim that high prices are needed to pay for overall R&D spend and investment – many payers see price as driven by nothing more than profit. The ball is in pharma's court to respond and really prove the prices they want represent value.

This report will enable you to...

Understand the diverse pricing and reimbursement environments in the US, UK, France, Germany, Italy and Spain

Deliver the real world data that is supportive of payer decision making

Appraise payer attitudes to innovative contracting and know why payment by results is not universally popular

Know what factors payers would like to see considered when setting prices

Leverage the value biomarkers and companion diagnostics have in gaining payer support

Appreciate the positive influence on payers of head-to-head clinical trial studies

Report Contents

Executive summary

Research methodology and objectives

Experts interviewed

Introduction

Pricing and reimbursement in Europe and the US

Cancer drug spend

Pricing and reimbursement mechanisms

Key Insights

Determination of drug price and reimbursement status

Europe

France

Germany

Case study: Opdivo (nivolumab)

Italy

Spain

United Kingdom (UK)

Blueteq system in the UK

United States

Factors and evidence that play a role in demonstrating value in payer decision-making

Key Insights

Robust data: clinical trial and real world

Cost effectiveness evidence: Health Technology Assessment (HTA)

Biomarkers and companion diagnostics

Other factors that can influence pricing and reimbursement decisions

Involvement of payers during drug development

Europe

United States

Cost to patient: out-of-pocket (US-specific)

Common versus rare cancers

Europe

United States

Financing mechanisms for cancer drugs: payment by results and risk-sharing agreements

Key Insights

Payment by results

Europe

United States

Value for money with cancer therapies

Key Insights

Justifying the high cost of the newer cancer therapies

Prohibitively high cost cancer drugs: push back or payer acceptance

Pricing a cancer therapy: component parts

Pricing by drug company

Reimbursement decision by payer

High technology has driven price hikes

Patient benefit as a function of cost

Cost-effectiveness

Quality of life as a measure of effectiveness

Pricing of cancer drugs compared to other therapeutic areas

Improved patient support – financial help programs

Formulating a cancer drug price: component parts

Drive for change in cancer pricing and reimbursement

Key Insights

Challenging high cancer drug prices

The substantial price hike in cancer therapy since 2000

Take home messages

France

Germany

Italy

Spain

United Kingdom

United States

Conclusion


1. Executive summary
2. Research methodology and objectives
3. Experts interviewed
4. Introduction
4.1 Pricing and reimbursement in Europe and the US
4.2 Cancer drug spend
5. Pricing and reimbursement mechanisms
5.1 Determination of drug price and reimbursement status
5.2 Europe
5.2.1 France
5.2.2 Germany
5.2.3 Italy
5.2.4 Spain
5.2.5 United Kingdom (UK)
5.2.6 Blueteq system in the UK
5.3 United States
6. Factors and evidence that play a role in demonstrating value in payer decision-making
6.1 Robust data: clinical trial and real world
6.2 Cost effectiveness evidence: Health Technology Assessment (HTA)
6.3 Biomarkers and companion diagnostics
6.4 Other factors that can influence pricing and reimbursement decisions
6.4.1 Involvement of payers during drug development
6.4.2 Europe
6.4.3 United States
6.4.4 Cost to patient: out-of-pocket (US-specific)
6.4.5 Common versus rare cancers
6.4.6 Europe
6.4.7 United States
7. Financing mechanisms for cancer drugs: payment by results and risk-sharing agreements
7.1 Payment by results
7.1.2 Europe
7.1.3 United States
8. Value for money with cancer therapies
8.1 Justifying the high cost of the newer cancer therapies
8.2 Prohibitively high cost cancer drugs: push back or payer acceptance
8.3 Pricing a cancer therapy: component parts
8.3.1 Pricing by drug company
8.3.2 Reimbursement decision by payer
8.3.3 High technology has driven price hikes
8.3.4 Patient benefit as a function of cost
8.4 Cost-effectiveness
8.4.1 Quality of life as a measure of effectiveness
8.5 Pricing of cancer drugs compared to other therapeutic areas
8.5.1 Improved patient support – financial help programs
8.6 Formulating a cancer drug price: component parts
9. Drive for change in cancer pricing and reimbursement
9.1 Challenging high cancer drug prices
9.2 The substantial price hike in cancer therapy since 2000
10. Take home messages
10.1 France
10.2 Germany
10.3 Italy
10.4 Spain
10.5 United Kingdom
10.6 United States
11. Conclusion

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