Developing a Creative Strategy to Present the Value of Oncology Drugs

June 22, 2017

At the 8th Annual Oncology Market Access & Pricing USA 2017 meeting hosted by eyeforpharma, Sriram Shankar, senior consultant, INC Strategy Consulting, shared his thoughts on the implications of value frameworks for payer strategy.

As the field of oncology gets increasingly competitive, drug developers are vying to present the value of their products to stakeholders, which includes payers, providers, and patients. At the 8th Annual Oncology Market Access & Pricing USA 2017 meeting hosted by eyeforpharma, Sriram Shankar, senior consultant, INC Strategy Consulting, shared his thoughts on the implications of value frameworks for payer strategy.

Shankar addressed the issue on several fronts:

  • What are the challenges with demonstrating value of new oncology drugs?
  • What are payer trends that can impact access to drugs?
  • What frameworks are payers using for value definition?
  • Implications for pharma strategy?

Demonstrating value, he said, is becoming increasingly challenging. As clinical options for care management expand, establishing value gains importance, especially with market competition from generics and biosimilars. Additionally, with the rising cost of oncology drugs, both payers and the healthcare system are stressed. “Payers, concerned with budget impact, are developing more stringent measures of value,” Shankar said.

He then pointed out the operational constraints associated with the existing clinical trial model: randomized controlled trials may not be sufficient. Not all payers will accept surrogate endpoints like progression-free survival and will desire real-world data, Shankar said. To top all of this, stakeholders have very broad definitions of value.

With a growing scrutiny of high-cost oncology drugs, US payers are implementing various management strategies for oncology drugs under medical benefit, Shankar said. There’s been increasing scrutiny of high cost oncology drugs which has raised the importance of demonstrating value to payers.

Payers have devised multiple strategies for oncology drugs under medical benefit:

  • The specialty pharmacy strategy to integrate pharmacy and medical benefit management
  • A biosimilars strategy that includes managed switching to a biosimilar, a plan only for new patients, and total switch plans. “One in 4 payers we interviewed said they have a biosimilars plan in place,” Shankar said, “And 87% of payers said if an FDA-approved biosimilar was available, it would be preferred over the reference drug, irrespective of interchangeability label.”
  • Alternate payment models that include bundled payments, value-based contracting, and episode of care payment
  • Indication-based contracting, which is gaining increased importance among payers, who, Shankar said, are waiting to extract additional rebates from manufacturers using this pricing strategy.

“Value is subjective and it lies in the eyes of the stakeholder,” Shankar said, citing clinical efficacy, health benefits, and societal benefits as significant contributors to the value of a product. “While clinical trial data is quantitative in nature, long-term health benefits and societal benefits may be intangible,” Shankar said, and payers may weigh these differently.

Stressing the importance of developing an integrated commercial and clinical strategy that is adaptable and future-proof, Shankar told the audience that in addition to collecting clinical data to strengthen their value proposition, drug manufacturers should be in continued dialogue with payers, prepare for post—health technology assessment and reimbursement negotiations, and work with external stakeholders to raise awareness around their new treatment.