Phyllis Kidder, PharmD, Principal Consultant, attended the recent PCMA Annual Meeting in Scottsdale and came away with two over-arching themes:
First, innovation and disruption in healthcare is here and will accelerate over the next few years. As Mostafa Kamal said “if you are not the disruptor, you are going to be disrupted”. Innovation encompasses technology, which is constantly changing at an ever-faster pace. The speaker gave non-healthcare examples such as film photography to digital, the taxicab industry to Uber, the evolution of the smart phone etc. But also discussed was that innovation needs to include the ways in which we deliver and pay for health care.
This leads to the second theme, around the need to restructure healthcare delivery and payment in order to be able to afford new therapies such as CAR-T and gene therapy that will provide cures. From a delivery perspective, there was discussion on increasing the use of telemedicine where appropriate to allow patients to be within a wider radius of a center of excellence for these therapies. There was much discussion on how to pay for a “one-time” therapy that provides a cure, even if in a cost-effectiveness analysis, it is deemed to be “cost-effective”, since one insurance plan is paying for a lifetime benefit for a patient. As a society, we would probably not accept denying access for these curative therapies, especially to children. There was discussion on the feasibility of outcomes contracting as well as the idea of an annuity. One concept that was raised more than once is that biosimilars could provide the “headroom” needed to be able to afford these newer therapies. That discussion was prior to the agreement between Amgen and Abbvie to delay the Amgen adilumumab biosimilar to 2023. That could clearly complicate the potential additional “headroom”.
All agreed that:
- In addition to the manufacturer and the payer, the provider needs to be at the table in both the delivery and payment discussions; if you think about hemophilia as the example, the entire hemophilia model (blood products, treatment center etc.) could drastically change if there is gene therapy to cure the disease
- Discussions between the manufacturer and the payer should start as early as possible
- Need to try to model outcomes; in discussing “cures” we need to rise above the current dialog and explore other options
- There are legislative / regulatory changes that need to occur around best price and AMP calculations to make outcomes based contracting a more viable option for manufacturers
Overall, it was a stimulating and thought-provoking two days, with more alignment between the manufacturers and PBMs, at least as put forth from the stage, than I have seen in the last few years. It will be fascinating to watch these topics unfold over the next few years.