Rational pricing strategies for patentholders

Transcription

1 Rational pricing strategies for patentholders in 2012 Presentation to SMi conference 7 February 2012 D.R. Glynn, Europe Economics

2 Introduction Europe Economics is an independent economics consultancy (see ) Healthcare and Pharmaceuticals Clients have included: industry big pharma and others Government Department of Health, European Commission and others

3 Big Pharma strategies are under review Existing patents expiring Fewer new medicines being approved E.g. FDA new drugs average 27 new drugs p.a. Profit forecasts, jobs down E.g. Astra Zeneca 7,300 jobs cut announced last week

4 Role of pricing Even more important than usual to establish optimal strategies for regulation and for pricing

5 Overview of presentation Rational strategies for patented products involve differentiated pricing in a national market, e.g. through Regional and therapeutic distinctions Risk sharing Contributions by patients Full use of private sector in the EU single market Differentiate prices via discounting from a high list price

6 Basic economics of a patented medicine Very high sunk costs Very low production / distribution costs in relation to value

7 Patent v non-patented product costs Patent 100% 80% 60% 40% 20% 0% Non-patent 100% 80% 60% 40% 20% 0% Time Time

8 Implication Pricing of patented product depends on willingness to pay, not on costs incurred in supply

9 Affordable access? Income differentials have become very great A desired medicine would be affordable (represent similar share of income) to: A banker at 1000 A politician at 100 Someone on UK average wage 15 Someone on UK minimum wage 5 Someone on low wage in Bulgaria 1

10 Basic Demand curve Price Consumer Surplus P Revenues Quantity

11 Relevance of steep demand curve Price discrimination can increase revenues significantly collar the consumer surplus of those who can afford it! And allow lower income patients who can still pay more than the production costs - to have access

12 A current example Arbiraterine a prostate cancer medicine from Janssen recently rejected by NICE (Scotland yet to decide!!) Drug mainly of benefit to elderly men Extends life and comfort but for few months Maybe 3,000 + potential patients Price? maybe 50,000 p.a Significant potential revenues

13 Risk sharing Time for this idea to be reinvigorated: New Government has an interest in outcomes-based procurement policies across the board. And in encouraging innovation Section 6 of the 2009 PPRS, now being reviewed, allowed risk sharing schemes but was negative it its comments. Following Richards Review, it is clear that private and NHS care can be combined Government response to consultation last year on how best to allow value-based pricing still thinking

14 Risk sharing Patent-holding company may well: Have more optimistic/realistic view than NICE on likely effectiveness e.g. tailored medicine initiatives Be able to improve odds of success with targeted support to hospitals, etc. helping to achieve better compliance Be able to involve private healthcare or invite co-payments in a way that NICE may not take into account

15 Likely snags of risk-sharing schemes in practice Experience of MS and other risksharing schemes very complex to prove success of medicines BUT Are right criteria being used? Better to be approximately right than exact but miss the boat

16 Patient contributions Co-payments received by NHS should be taken into account by NICE in cost calculations Sales through private healthcare can be at higher prices differentiating according to willingness to pay

17 Potential of risk-sharing & patient contributions: a theoretical illustration Conventional pricing Per 100 potential patients: Price acceptable to NICE 1 Sales revenues 100 Expected success rate say 25% Cost to NHS per successful treatment 4 Risk-sharing & patient contributions Per 100 potential patients: Additional effort to ensure and demonstrate effective delivery of medicine: cost say 10 Price accepted by NICE per success 4 Success rate higher, say 33% Sales revenues net of extra costs [(33* 4)- 10] = 122 Additional payments by patients say average 1 per success = 33 Addition to profit = 55

18 Summary re UK Health policy is in a flux; public finances very limited; new cast of decision-takers Private demand should be tapped wherever possible Patients who can afford to do so would want to pay for some medicines not meeting NICE s criteria Therefore: price discriminate through energetic use of private sector/ copayments/ risk-sharing schemes

19 The EU single market EU law facilitates parallel trade But parallel trade is harmful to patients How best to limit or prevent it?

20 Most traded products have included Lipitor and Cozaar (Cardio) Zyprexia, Risperdal and Effexor (Central Nervous System) Casodex, Zoladex and Armidex (Oncology) Nexium (Gastro-Metabolism) Plavix (reduced atherothrombosis) Seetide and Symbicort (asthma) Important patented medicines for serious conditions

21 Harm to patients arising from // trade Vast majority of million packages a year are re-packaged

22 Disadvantages for patients 1: Reduced safety Any interference with original packaging carries some risk of contamination Significant proportion of leaflets in // trade packages are out of date Increased ease of access for counterfeits

23 Disadvantages for patients 2: Less secure supply Periodic stock-outs, despite legislation for continuous supply. Product recalls are less reliable where supply chain is obscure Delayed introduction to market in lower income countries

24 Disadvantages to patients 3: Reduced innovation Reduced profitability of successful R&D Reduced incentives to invest

25 Disadvantage for patients 4: Less affordable access Parallel trade causes prices to converge Price level will converge to optimal level for patent-holder, not to lowest possible cost of production This means poorest will have to pay more, a reduction in affordable access to key medicines within the EU

26 Effects of price convergence

27 What would be the ideal EU price levels? Assume GDP/capita of a country is roughly proportional to the price which a Member State s health service would wish to pay

28 Notional demand curve for typical patented medicine would be:

29 Optimal price Revenues would be maximised by charging price slightly below 100 on this measure (about the same as to a Member State with average income levels) About one third of patients in the EU would have to pay significantly larger fractions of their income, or be denied access

30 Countries most affected EU Member States whose GDP per head is less than half the EU average are: Bulgaria Latvia Slovakia Estonia And now probably Greece Romania Poland Hungary Czech Republic Combined population exceeds 100 million

31 Comparison of single price with differentiated pricing

32 Parallel trade reduces price differentiation, harms patients, reduces rewards for innovation So how best to limit or prevent it?

33 Compliance with EU law EU legislation prohibits barriers to trade including // trade However, there is scant social or economic justification for this law and so little need to obey its spirit as opposed to its letter

34 The single EU market Do not over-estimate the extent to which the single market is so far generally effective Examples: Public procurement as a whole Less than 3% of contracts go to non-national suppliers Medtech Stents times more expensive in France than the UK for same product from same suppliers Dutch hospitals typically pay 25% more that German counterparts Reagents probably much larger differences, in line with diagnostic test prices Generics A study by Europe Economics found significantly higher prices are paid in Portugal than the UK

35 Practical measures to inhibit // trade Well explored possibilities include Litigation Packaging Controlling supplies Discounting from a single EU list price Product differentiation (Including special risk-sharing arrangements) Warning patients about risks of repackaging etc. Continued lobbying for changes to the law

36 Selecting a pricing strategy Alternative possible strategies for pricing in the EU include: A single EU price Different list prices in each Member State A single EU price with negotiated discounts to reflect particular circumstances

37 The most attractive option A single high EU list price plus negotiated discounts Discounts conditional on local circumstances and on (e.g.) own use rather than re-selling a means of charging different prices according to ability and willingness to pay Therefore result in better sales, and better profits

38 How much does this matter in practice? On indicative calculations, volumes supplied and profits are both about one third lower with a single price than with differentiated pricing

39 Conclusion General pricing strategy maximise price differentiation, within national markets and in EU as a whole Risk sharing and co-payments ideas whose time has finally come? Benefit for affordable patient access throughout the EU for profits and for innovation