OBJECTIVES: With the introduction of new, advanced and expensive therapies, global payers endeavor to manage their drug risk/spending. A potential solution is to enter into contracts/arrangements, with pharmaceutical manufacturers, in which price/reimbursement varies based on drug indication. This research explores current and future trends for IBPC, by market, along with barriers to implementation.

METHODS: Primary and secondary research were used. Subjects included 52 payers from US, Canada, and EU-5. Payers were defined as individuals who influenced coverage and reimbursement decisions made by health authorities or insurers. Literature searches on utilization management were conducted by market to gain insight and inform primary research, which consisted of online surveys and telephone interviews. All data and information were tabulated and analyzed.

RESULTS: No payers identified current examples of IBPC. Several payers identified the concept as a potential solution for managing drug spending, while all identified issues with the complexity of implementation in their markets. In the US, payers demonstrated interest in IBPC for rheumatoid arthritis, psoriasis, and ulcerative colitis due to the perception that there are drugs which may be strong in one indication, but weaker in another. Payers from ex-US countries, with the exceptions of France, had limited interest in IBPC due to current statutory regulations that limit drug price increases and that reduce drug reimbursement as volume increases. Payers from France expressed interest in IBPC and suggested a potential framework that included reimbursement based on epidemiologic data and the potential for assigning different ASMR levels for a drug if the clinical added value differed by indication.

CONCLUSIONS: As the prices of new advanced therapies continue to rise, payers in selected markets are likely to adopt IBPC, and if successful, payers in other markets are likely to follow. Pharmaceutical manufacturers need to prepare for this eventuality by exploring innovative IBPC strategies.