Payers Need Three Things
1 – Relevant Innovation & Evidence
- Relevant innovation addresses patient unmet needs. The price for something a payer doesn’t need is always too high.
- Robust efficacy and effectiveness evidence based on selecting relevant:
- Comparators
- Endpoints
- Patient populations
2 – Appropriate Use (Place in Therapy)
- Appropriate use is based on a drug’s evidence.
- Appropriate use includes starting and stopping rules.
3 – Predictable Value (benefit / cost)
- A drug’s benefit is supported by phase 3 efficacy and phase 4 effectiveness evidence.
- A drug’s value (benefit / cost) remains stable from launch through phase 4.
Insights for Pharmaceutical Companies
1 – Evidence is King
- Maybe the company understands that FDA registration does not equal commercial success. Maybe. How is this knowledge reflected in the generation of efficacy and effectiveness evidence?
- Are the efficacy and effectiveness research questions and study methodologies relevant to payers?
2 – Focus on Benefits, Not Features
- A feature is something that is true, but not always relevant. Drug X may be the first drug with its Mechanism of Action (MOA), but how does a new MOA address the patient unmet need?
- While a unique MOA can be a reason to believe a drug’s clinical value, a feature by itself is not likely compelling to payers. Focus on benefits.
Recommendations For Pharmaceutical Companies
1 – Have a Clear Strategy
- Sun Tzu stated, “Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.”
- What is your strategy to meet payer needs, provide durable value and achieve commercial success?
2 – Align
- Align a drug’s clinical and economic evidence with pricing, marketing and sales strategy and tactics.
3 – Collaborate
- Be the first pharmaceutical company that payers, prescribers and patients want to collaborate with to improve the health outcomes of patients. Beyond a press release. Real collaboration.
- Collaboration is key to solving the Gordian knot of delivering low cost, high quality, high access healthcare.
