You've certainly heard, "location, location, location." If you follow Microsoft you've heard, "developers, developers, developers." And now, if you're a believer in patient-centric reimbursement policies, there's a new triad, "outcomes, outcomes, outcomes."
It's about time.
The story in today’s New York Times is headlined, “Drug Deals Tie Prices to How Well Patients Do,” but it could just as easily have been called, “Payers and Phama Focus on Patient-Centric Care.”
The article, by the always excellent Andrew Pollack, begins thus:
“Pressed by insurance companies, some drug makers are beginning to adjust what they charge for their drugs, based on how well the medicines improve patients’ health.”
Outcomes baby!
Pollack writes:
“In a deal expected to be announced Thursday, Merck has agreed to peg what the insurer Cigna pays for the diabetes drugs Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood sugar. And last week, the two companies that jointly sell the osteoporosis drug Actonel agreed to reimburse the insurer Health Alliance for the costs of treating fractures suffered by patients taking that medicine.”
Put up or shut up? That’s about the size of it. But it cuts both ways.
“We’re standing behind our product,” said Dan Hecht, general manager of the North American pharmaceutical business of Procter & Gamble, which sells Actonel with Sanofi-Aventis. “We’re willing to put our money where our mouth is.”
This outcomes-based strategy was first tried in Great Britain for the Johnson & Johnson drug Velcade and most recently for the Pfizer drug Sutent.
J&J won coverage in 2007 after agreeing to pay back the government for people who didn’t benefit. Patients get the first four doses of the 762.38 pound drug, and then are tested to see if they’ve responded to the treatment. Those who improved continue with the drug. Johnson & Johnson provides a rebate of about 3,000 pounds for those who didn’t respond.
For Sutent, the U.K.’s National Health Service (via NICE) decided the medicine extended the lives of patients enough to justify its cost, as long as the first course of treatment was free.
According to Sir Michael Rawlins, Chairman of NICE, “We’re meeting them partway.”
It's a creative approach based on outcomes -- a giant step towards recognizing the importance of personalized medicine the folly of basing reimbursement decisions on large-scale general population studies.
And such strategies are also being designed to improve compliance. Pollack continues:
“Some discounts will be granted if more people diligently take the drugs as prescribed. This helps both Cigna, because people who take their pills are likely to have fewer complications from the disease, and Merck, because it sells more pills. The assumption is that Cigna will push for patient-compliance programs that urge people to take their medicine at the right times and in the proper doses.”
Imagine that, an access/reimbursement program that actually helps advance the four rights of 21st century personalized medicine – the right medicine for the right patient in the right dose at the right time.
Sure beats a myopic, QALY-based view that puts cost ahead of care.
Pollack quotes Eric Elliott, the president of Cigna Pharmacy Management:
“We wanted a contract that drives performance,” he said. “Getting this one out will provide more momentum.”
Focusing on outcomes not only means that Pharma will have to put their money where their mouth is – but that payers will have to put patients first.
Now that’s healthcare reform.
The complete New York Times story can be found here.
It's about time.
The story in today’s New York Times is headlined, “Drug Deals Tie Prices to How Well Patients Do,” but it could just as easily have been called, “Payers and Phama Focus on Patient-Centric Care.”
The article, by the always excellent Andrew Pollack, begins thus:
“Pressed by insurance companies, some drug makers are beginning to adjust what they charge for their drugs, based on how well the medicines improve patients’ health.”
Outcomes baby!
Pollack writes:
“In a deal expected to be announced Thursday, Merck has agreed to peg what the insurer Cigna pays for the diabetes drugs Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood sugar. And last week, the two companies that jointly sell the osteoporosis drug Actonel agreed to reimburse the insurer Health Alliance for the costs of treating fractures suffered by patients taking that medicine.”
Put up or shut up? That’s about the size of it. But it cuts both ways.
“We’re standing behind our product,” said Dan Hecht, general manager of the North American pharmaceutical business of Procter & Gamble, which sells Actonel with Sanofi-Aventis. “We’re willing to put our money where our mouth is.”
This outcomes-based strategy was first tried in Great Britain for the Johnson & Johnson drug Velcade and most recently for the Pfizer drug Sutent.
J&J won coverage in 2007 after agreeing to pay back the government for people who didn’t benefit. Patients get the first four doses of the 762.38 pound drug, and then are tested to see if they’ve responded to the treatment. Those who improved continue with the drug. Johnson & Johnson provides a rebate of about 3,000 pounds for those who didn’t respond.
For Sutent, the U.K.’s National Health Service (via NICE) decided the medicine extended the lives of patients enough to justify its cost, as long as the first course of treatment was free.
According to Sir Michael Rawlins, Chairman of NICE, “We’re meeting them partway.”
It's a creative approach based on outcomes -- a giant step towards recognizing the importance of personalized medicine the folly of basing reimbursement decisions on large-scale general population studies.
And such strategies are also being designed to improve compliance. Pollack continues:
“Some discounts will be granted if more people diligently take the drugs as prescribed. This helps both Cigna, because people who take their pills are likely to have fewer complications from the disease, and Merck, because it sells more pills. The assumption is that Cigna will push for patient-compliance programs that urge people to take their medicine at the right times and in the proper doses.”
Imagine that, an access/reimbursement program that actually helps advance the four rights of 21st century personalized medicine – the right medicine for the right patient in the right dose at the right time.
Sure beats a myopic, QALY-based view that puts cost ahead of care.
Pollack quotes Eric Elliott, the president of Cigna Pharmacy Management:
“We wanted a contract that drives performance,” he said. “Getting this one out will provide more momentum.”
Focusing on outcomes not only means that Pharma will have to put their money where their mouth is – but that payers will have to put patients first.
Now that’s healthcare reform.
The complete New York Times story can be found here.
