Evaluating Payer Opinion versus Behavior for Better Decision Making

Transcription

1 Evaluating Payer Opinion versus Behavior for Better Decision Making Elizabeth Sampsel, PharmD, MBA, BCPS Vice President, Payer Strategy and Relations, Dymaxium, Inc. Allen Lising Chief Executive Officer, Dymaxium, Inc. Specifically this Webinar will review: 1) The significance of the shifting landscape and the need for credible insights 2) Utilizing payer insights to make better informed market access decisions 3) Evaluating payer opinion versus behavior/case study examples 1

2 Shifting landscape Considerable discussions occurring at US federal and state levels regarding a potential repeal and replace of the ACA Market price pressure due to availability of new, innovative therapies A full pipeline with primarily specialty and orphan drugs, requiring decision-makers to have more information sooner. Need for Credible Insights Payers and other health care decision makers are balancing tight budgets with offering new therapies Pharma organizations are investing in innovative therapies and require information to best plan to make products available to patients 2

3 Balancing Stakeholder Requirements Payers Pharma Complete, useful Information Provision of complete, useful information Timely Information Potential timeliness challenge Resource Restraints to do reviews Formulary Decisions Provide packaged information Market Access Complete, useful information Need Payers need complete information for formulary decisions, packaged in the most usable format Challenge Complete information is not always available Payers may not be asking for information in the best possible way Solution Payers request information in AMCP Format v4.0 Involve payers in the study design and economic model design 3

4 Timely Information Need Payers need information in a timely manner in order to meet budget and formulary submission requirements Challenge Timeliness can be an issue Pharma regulatory boundaries slows timeline to get information to payers Pharma communication of when specific information will be available to payers Solution Dossiers and other evidence provided in AMCP edossier System and through the Manufacturer Evidence Library; System can control who has access, can track; FDA Draft Guidance info exchange; Format addresses preapproval information When payers request information, let them know if/when information will be available Resource Restraints to do reviews Need Payers require the information they ask for in a concise, efficient format Challenge Payers have limited time and resources to do formulary reviews Important information may be omitted from consideration in formulary reviews if payers do not have access Communication to payers when requested information will be available Solution Provide Dossier information in AMCP edossier System following AMCP Format v4.0 Involve payers in the study design and economic model design 4

5 Opportunity for Payer Insights Payer Insights Clinical Trial Design AMCP Format and System Development Economic Model Design Peer Insights for PAYERS Market Access Planning for PHARMA A more efficient, effective process for both Payers and Pharma. AMCP edossier System@FormularyDecisions.com Evidence Horizon and Resources Library Product Evaluation Apps and Interactive Tools FD Focus newsletter AMCP edossier System for US Formulary Decisions US P&T Competition Manufacturer Value edossiers BIM / CE Templates. Manufacturer emodels Evidence Comparison and Drug class reviews Global Future HCDMs P&T monographs and presentation templates HTA Review and Peer Insights A central source of Evidence, Insights and P&T Tools to support formulary decision makers with starting their product evaluation. A central erequest tool. Interactive edossier. Integrated P&T Tools - saving time and improving efficiencies. 5

6 Evaluating payer opinion versus behavior: Case Study edossier Sections Payers found most Useful* Weighted Score (out of 4) Product Information and Disease Description *Based on Payer Survey July 2016 (n=54) Economic Value Clinical Summary Executive Summary edossier Sections Most Accessed edossier Sections based on Page Hits* 8.33% 4.69% 2.50% Product Information and Disease Description Economic Value 13.01% 41.86% Clinical Summary Executive Summary 29.60% Other Supporting Evidence References *Aggregated metrics from 10 selected edossiers Evaluating payer opinion versus behavior: Case Study 2 *Source: DRG Fingertip Formulary, April

7 Evaluating payer opinion versus behavior: Case Study 2 (continued) *Source: DRG Fingertip Formulary, April Evaluating payer opinion versus behavior: Case Study 3 30% When do Payers Initiate the Majority of Pipeline Research? Responses: % actively involved in pipeline research 20% 10% 22% 22% 15% 18% 8% 15% Survey Demographic 46% MCO 27% PBM 19% Hospital/Health Systems 7 % Other 0% Within 6 months prior to approval 6 12 months prior to approval months prior to approval months prior to approval 24+ months prior to approval Other (I don't know, post approval, etc...) 85% prior to approval Earlier review required for formulary positioning and budget forecasting 7

8 Evaluating payer opinion versus behavior: Case Study 3 (continued) 130 Number of erequests for Pipeline Products 125 Number of erequests % increase from 2016 in only 5 month YTD (May) Manufacturer requests data for pipeline product info Evaluating payer opinion versus behavior: Case Study 3 (continued) Non-manufacturer pipeline content usage metrics 8

9 Evaluating payer opinion versus behavior: Case Study 4 1 Payer Access to ICER Reports by Organization Activity calculated based on number of hits for Institute for Clinical and Economic Review throughout the System Apr 2016 May 2017 Managed Care Organization (MCO) 8178 Pharmacy Benefit Managemnet (PBM) 3848 Hospital/Provider 1169 Public Health/Government* 889 Drug Information Center 760 Others 371 *Includes Medicare, Medicaid, etc. Number of Hits 1 Based on Payer Survey May 2016 (n=99) Conclusion 1) The US healthcare landscape continues to evolve and the need for credible, timely insights is important for both payers and pharma 2) Payer insights allow for more informed decisions in an efficient, effective manner 3) Combined qualitative opinions and quantitative metrics are ideal 9

10 Discussion & Questions Thank you for participating! For any questions, contact 10