Presentation (CTI)

OBJECTIVES: Amid the growing incidence of HER2 positive breast cancer (HER2+ BC) in Ireland, budget uncertainty poses a significant challenge for the healthcare system. To enable and encourage broad accessibility to HER2+ BC treatment in Ireland, a pharmaceutical company and private health insurer co-created an innovative pricing model, resembling a subscription-based payment system. This model endeavours to offer both the pharmaceutical company and private health insurer enhanced budget certainty, while ensuring that cost is not the barrier to the right treatment for patients.
METHODS: The subscription model was developed by analysing historical payment data, vial usage and patient figures. Future patient numbers, considering the changing competitive therapeutic landscape, were forecasted to determine both an average treatment cost per patient (patient approach) and total average treatment cost (cohort approach) per month irrespective of treatment received. Actual monthly patient numbers and rebate amounts were tracked against the model's estimates.
RESULTS: A shadow contract was run in 2024 alongside the annual commercial agreement to validate the model accuracy and demonstrate proof of concept. The model demonstrated 98% accuracy in the patient approach and 91% accuracy in the cohort approach. Both methods demonstrated an overestimate of rebate values compared with the currently operating commercial model.
CONCLUSIONS: The pilot demonstrated that setting monthly rebate values over an annual period can achieve accuracy within ±10% with improved accuracy achieved through a patient treatment value over a cohort value. Through this pilot we have demonstrated that the utilisation of a subscription-based payment model is feasible enabling optimal treatment for patients while maintaining budget certainty for payers and pharmaceutical companies. We anticipate with advances in forecasting though AI and other methods, the margin for error can be greatly reduced and this model can potentially be rolled out at a portfolio level for the benefit of patients.