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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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  [Published by FirstWord 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
|Title||Date Published||Price from||More Details|
| Physician Views: A Victoza competitor in waiting? – Can Eli Lilly's dulaglutide make an impact in the GLP-1 agonist market?|
Scope Last week, Eli Lilly confirmed that in the head-to-head AWARD-6 study its experimental GLP-1 a...
|05 Mar 2014 by FirstWord Pharma||USD $591 (normally
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|01 Jan 2014 by FirstWord Pharma||USD $591 (normally
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ScopeSales of Biogen Idec’s multiple sclerosis therapy Tecfidera may continue to exceed initial expe...
|01 Nov 2013 by FirstWord Pharma||USD $591 (normally
| The Impact of Mobile Health on Patient-Centric Disease Management|
IntroductionBanks use them. So does the travel industry. And tastemakers are harnessing their power ...
|01 Aug 2013 by FirstWord Pharma||USD $591 (normally
| Value-based Key Account Management and the NHS — ensuring optimal performance under new rules|
IntroductionCCG commissioners want pharmas money and expertise but on their terms how do you deve...
|01 Jun 2013 by FirstWord Pharma||USD $591 (normally
| Physician Views: Recent developments in US diabetes market – impact of safety concerns & emergence of SGLT-2 drug class|
ScopeWith the diabetes market an important therapeutic area for a host of pharmaceutical manufacture...
|01 Jun 2013 by FirstWord Pharma||USD $591 (normally
| Ensuring Optimal Medical Affairs Performance: Delivering Measurable Value|
IntroductionIn this era of transparency, Medical Affairs is rapidly becoming the new voice of Pharma...
|01 May 2013 by FirstWord Pharma||USD $591 (normally
| Leveraging the iPad to Optimise MSL Impact|
IntroductionAlthough 80 percent of pharma companies have already deployed iPads to their sales reps,...
|01 Oct 2012 by FirstWord Pharma||USD $591 (normally
| Tiered Pricing Strategies in Emerging Markets|
IntroductionFor the pharmaceutical industry, emerging markets are dynamic, full of potential and off...
|01 Feb 2012 by FirstWord Pharma||USD $591 (normally
| Pricing and Reimbursement Trends in the US: Impact of Comparative Effectiveness Research and Cost-Effectiveness Analysis|
IntroductionPublic healthcare costs are rising. Governments need to get them under control. In Europ...
|01 Jan 2012 by FirstWord Pharma||USD $591 (normally
This report is published by FirstWord Pharma
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