BLACK BOX AMNOG REBATES- WHAT IS DRIVING THE PRICE IN THE NEGOTIATION WITH THE GKV-SPITZENVERBAND?

Author(s)

Freiberg M1, Pruefert A2, Hepp S3, Schalber T3
1Quintiles Consulting, Neu-Isenburg, Germany, 2Quintiles Consulting, Hoofddorp, The Netherlands, 3Quintiles Commercial, Mannheim, Germany

OBJECTIVES Price negotiations of a pharmaceutical company with the German GKV-Spitzenverband (Association of Statutory Health Insurance) after early benefit assessments can be considered a black box. This analysis aims at providing insights on the parameters that drive the final rebate to predict future pricing decisions and to enhance the negotiation strategy and therefore secure optimal pricing. METHODS Published benefit assessments from the G-BA (Federal Joint Committee) website and the products’ prices as listed in the German pharmacy selling system were used as a basis for research. The latter allows a comparison of launch prices (manufacturer selling prices) and prices after the negotiation with the GKV-Spitzenverband (reimbursement prices). The following parameters were analyzed: Rebate size, rebate by added benefit rating, and rebate by therapeutic area. RESULTS By June 2014, 36 products had been through price negotiation, with the rebate of the launch price ranging from 5-71% (average: 25%). The rebate of products with considerable benefit rating ranged from 10-35% (average: 21%). Products with minor added benefit reached rebates between 5-48% averaging at 23%. Products with no quantifiable benefit yielded rebates ranging from 11-44% (average: 24%). Products with no additional benefit had a rebate between 5-71% averaging at 27%. Products in oncology yielded an average rebate of 27%., followed by endocrinology (23%), central nervous system (22%), cardiovascular (21%), and infectious diseases (16%). CONCLUSIONS The better the added benefit rating of a product, the lower is its negotiated rebate. However, only marginal average differences were observed. The rebate per therapeutic area did not reveal obvious patterns: Assessments for oncology products resulted in above average rebates, while rebates for products for infectious diseases were far below the average.

Conference/Value in Health Info

2014-11, ISPOR Europe 2014, Amsterdam, The Netherlands

Value in Health, Vol. 17, No. 7 (November 2014)

Code

PHP137

Topic

Health Policy & Regulatory

Topic Subcategory

Reimbursement & Access Policy

Disease

Multiple Diseases

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