OBJECTIVES:

To understand impact of COVID-19 on payer business practices in the US and EU5, MME conducted individual surveys and an advisory board.

METHODS:

US: Online surveys in March and April 2020 with Managed Care Pharmacy and Medical Directors representing Commercial and Medicare lives (61 total interviews).

EU5: EU5 advisory board with 8 payers / advisors conducted virtually in March 2020. These interactions are part of an ongoing effort that MME intends to build upon moving forward into 2021.

RESULTS:

US and EU5 experiences and emerging issues have both commonalities and differences. All payers reported significant disruptions due to COVID-19, while moving from an unprecedented crisis situation full of “unknowns” towards more stable operations even in the “early days”.

US:

• Short term: Biggest concern was strain on provider and hospital networks as well as unplanned cost increases and patient treatment interruptions. In person pharma partner meetings - regarding new products, contracts, etc. – were also postponed or cancelled.
• Longer term: Concerns regarding premium flow (due to spike in unemployment) and need to re-prioritize (e.g. P&T reviews / contracting negotiations towards new / high PMPM / financial impact meds); increased support for tele-medicine.

EU5:

• Short term: Increased focus on healthcare as key national priority and shift burden away from acute to ambulatory care, where possible.
• Longer term: Re-prioritization challenges regarding supply chain, investments in healthcare, improving pan-EU communication and coordination at all levels. More complex price negotiations expected as economic crisis negatively impacts market access for high cost / innovative therapies.

CONCLUSIONS:

COVID-19 pandemic is causing significant disruption to how payers conduct business. As priorities are adjusted, all payers expect clinical value and price justification for treatments will come under increasing scrutiny, although the lens to view them may also evolve.