The pay for performance agenda gathers pace as US payers rebel the cost of drugs.
Pharma is in the firing lineas fundamental change sweeps across the US health delivery sector. Driven by unsustainable growth in drug costs, health payers want therapies that prove to deliver better patient outcomes at a lower cost. Under mounting pressure, what can Pharma do to ensure positive payer support for its pricing proposals?
Pay-for-Performance and Drug Pricing Pressure: Impact and Response from Pharma intensively examines the drivers and the players involved through informed opinion, detailed secondary research and instructive case studies.
“Long term, what may have to happen is that government may have to step in. Whether it's Medicare or Medicaid, each may have to negotiate a better pricing option.” US Payer
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Key Topics explored
The report is informed through in-depth interviews with payers, advisors and clinicians. To ensure open and critical responses some contributors identities have been kept anonymous:
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Table of Contents
for Pay-for-Performance and Drug Pricing: Impact and Response of Pharma 
1 Executive summary
2 Research objectives and methodology
4 Traditional pay-for-service reimbursement
4.1 Key Insights
5 Shift to pay-for-performance reimbursement
5.1 Key Insights
5.2 Medicare approach
5.3 Non-Medicare approach
6 Positive pharmaceutical company strategies
6.1 Key Insights
6.2 Increasing use of head-to-head clinical studies
6.3 Individual drug risk-sharing strategies
6.3.1 The challenges of tying drug performance to patient outcomes
6.3.2 The value of shared risk programmes in Europe
6.4 Balancing cost and benefit
6.5 Restrained drug launches
6.5.1 Novel biologics for dyslipidaemia
6.6 Case study: Novel hepatitis C cures
6.7 Recapturing market share in the face of innovative therapies
6.8 Other pay for performance pharma strategies
6.8.1 Case study: Initial three-drug treatment of type 2 diabetes
7 Negative pharmaceutical company strategies
7.1 Key Insights
7.2 Shadow pricing
7.2.1 Case Study: MS drugs raise prices with each drug launch
7.3 Drugmaker-sponsored programmes to offset steeper co-pays
7.4 Revenue gains still possible despite modest efficacy
7.5 Creating non-standard clinical efficacy endpoints
8 Reducing Pharmacologic Costs of Oncology Treatments
8.1 Key Insights
8.2 Background on cancer therapies and cost effectiveness
8.3 Case Study: FDA’s revocation of approval of Avastin to treat metastatic breast cancer
8.4 Companion diagnostics leveraged to demonstrate value of NSCLC therapies
8.5 Diagnostic tests could help demonstrate value to payers
8.6 Oncologists’ editorial regarding ‘unsustainable’ cancer drug pricing
8.6.1 Allowing CMS to negotiate drug prices
8.6.2 Creation of value-based system of reimbursements
9 Contributor Biographies
9.1 Report Writer
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This report is published by FirstWord Pharma
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