NOVEL DRUG REIMBURSEMENT MODELS- LESSONS AND IMPLICATIONS FROM CANCER DRUG ACCESS SCHEMES
Author(s)
Aggarwal SNovel Health Strategies, Bethesda, MD, USA
OBJECTIVES: Cancer drugs are the world's highest selling category of therapeutic products. Due to their premium price and budget impact, several new drug reimbursement models have been implemented worldwide by public and private payers. These models have potential implications for coverage and reimbursement of all branded products. This study reviewed recent cancer drug reimbursement models and developed lessons and implications for future products. METHODS: Reviewed cancer drug reimbursement schemes in developed and emerging markets. Interviewed payers and KOLs to develop lessons and implications for future products. RESULTS: Public and private payers worldwide have implemented several new models for cancer drug reimbursement to manage budgets and control costs. In the US, private payers are piloting single source compendia and third party protocols (eg. P4 Oncology) to limit off-label use of cancer drugs. In the UK, NICE has successfully negotiated lower price and discounts for first few cycles of therapy. In Italy, AIFA has implemented registry based patient access for cancer drugs. In India, several manufacturers have implemented novel pricing strategy for first few cycles of therapy. In Germany, IQWIG has proposed to use correlations between surrogate endpoints and patient relevant outcomes to determine value of cancer drugs. Due to increased cost pressure on payers, such models are likely to inspire novel reimbursement schemes for other branded products. CONCLUSIONS: Cancer drug reimbursement models are setting new benchmark for payers to manage access and control costs. These models have significant implications for other expensive branded products.
Conference/Value in Health Info
2011-11, ISPOR Europe 2011, Madrid, Spain
Value in Health, Vol. 14, No. 7 (November 2011)
Code
PHP156
Topic
Health Policy & Regulatory
Disease
Multiple Diseases