Events: World Pharma Pricing Market Access & Evidence Congress 2020

Last month, several members of Research Partnership’s specialist market access team, including Directors Brett Gardiner and Rachel Howard, attended the virtual World Pharma Pricing Market Access & Evidence Congress. This two-and-a-half day online event brought together over 1,000 stakeholders from the pharma and biotech industry with HTAs, payers and solution providers from across the globe.

Key theme: The sweeping impact of COVID-19

The major talking point throughout the conference was of course the COVID-19 pandemic. This is understandable given it was not only responsible for moving this year’s conference from a physical venue to an online event, but also because it has had vast repercussions on healthcare more generally.

When it comes to biopharmaceutical market access, speakers acknowledged that the pandemic has resulted in some positives. Plenary session chair, Navin Joshi of GSK, described the pace of the pharma industry in reacting to the virus as “unimaginable”. Additionally, the degree of collaboration between the industry and public organisations is unprecedented, and payers are having to make market access decisions more quickly than ever before, as we have seen for ourselves in our recent syndicated study.

On the flip side, COVID-19 has also put many of our assumptions prior to the pandemic in flux. Attitudes of healthcare professionals and payers alike have shifted due to the pandemic. We were reminded not to assume that anything is the same as it was before, and consider what impact these changes will have on our industry more broadly. One particularly emotive session drew attention to the struggles of funding for rare disease research as a result of COVID-19 diverting priorities. It is estimated that a third of non-profits in this space may be forced to shut down this year and the progress of rare disease clinical trials is being seriously threatened.

Ryan Saadi, CEO of Tevogen Bio, drew attention to how the pandemic has forced those of us working in pricing and market access to confront new challenges, arguing that it has elevated market access to become the single most important function within pharmaceutical companies. If an effective vaccine or therapy is developed, we have a collective responsibility to reconcile the pharmaceutical companies’ need for a fair return on investment with the public health objective of ensuring broad access. It is clear no single organisation will be able to find a solution by acting alone, and collaboration between multiple parties will be required.

The other question we delegates were left to ponder is how the learnings from this time can be taken forward to help address the unmet needs that remain in other disease areas. Can the cross-platform, multi stakeholder, international collaborations we have witnessed continue and be applied to situations outside of the pandemic?

A series of thought-provoking breakout sessions throughout the conference considered other aspects of the pharma industry thathave been less directly impacted by COVID-19. One such session explored the nuances of virtual research in clinical trials. Already starting to trend prior to the pandemic, interest in #VirtualResearch has exploded in recent months out of necessity – but industry and payers alike remain cautious about implementation. As virtual data collection in the clinical trial setting enters the mainstream, a clear working definition and taxonomy of active vs. passive approaches will be essential to guide best practice and interpretation.

Other hot topics: Defining ‘value’ in different settings

Outside of the topical issue of the moment, we noticed the unresolved issue of how best to ensure access to Advanced Therapy Medicinal Products (ATMPs) is still a subject of passionate panel debate. So too is the challenge of finding a way to integrate all relevant stakeholders’ perspectives when speaking about value. Several speakers chose to hone in on CAR-T, detailing how such therapies are leading the way for many ATMPs at both the regulatory and payer level. After an initial ‘transition period’ payers and regulators became more adept at overcoming uncertainty that was presented to them in dossiers, particularly those surrounding QoL, small sample size and time horizon / treatment effect. Payers and regulators became more accepting of modelling assumptions that enable outcomes to be mapped by using similar disease states. Interestingly, it appears that the key driver for doing so were the patients themselves and the high unmet need that must be overcome.

Brett Gardiner attended a session by Charles De Cidrac, Director of Health Insurance at AXA, who outlined what value means for private payers. He started with a win: win proposition that is core to his perspective: the best patient is one that doesn’t become sick. Avoidance of illness is better not only for them but for the insurance company – hence investment in prevention and early disease management is key for his organisation. When it comes to treatment, there is a need to reconcile medical value with financial value. Charles explored whether value to the patient can be increased by new insurance models. These include pay for coordination, pay for performance and total cost of care / shared savings programmes, all of which generate incentives for healthcare providers and/or manufacturers to deliver value. Vertically integrated models, in which the payer is also the provider, can also incentivise value delivery because they span both sides of the equation, generating a desire to reduce total cost of care while also demonstrating improved health outcomes.

In another session, Rabia Kahveci of Management Sciences for Health, explored how the meaning of value in Low and Middle Income Countries (LMICs) deviates from the classical definition of outcomes divided by costs. This is due to differing burden of disease, priorities, socio-cultural values and costs, as well as limited data on costs or quality of life in these settings. It is therefore often difficult to predict which innovations will be granted access. Rabia posited a new definition of value in these settings as health outcomes that matter to patients (which could in some settings be as simple as being able to see a doctor) divided by the costs of delivering these outcomes. Evaluation should not be restricted solely to currently available alternatives, but also build potential future options into consideration.

Market-specific developments

Throughout the conference, the other team members followed different ‘tracks’, covering a range of topics pertinent to our work including Real World Evidence, Evidence Generation in multiple therapeutic areas such as Rare Diseases and Oncology, Market Access, Value-Based Contracting and Risk Sharing Arrangements.

Artemis Rizoglou, Analyst, attended a talk on access, pricing and HTA considerations for CAR-T therapies in Europe.  She was very keen to learn  what would be the main value drivers for access for CAR-T therapies. While there is an acknowledgment that CAR-T will pose a significant financial burden to healthcare systems, HTA evaluation committees are expected to evaluate beyond cost-effectiveness and incorporate broader value elements such as disease burden and unmet needs into the evaluation.

The conference also provided us with an opportunity to update ourselves on the latest developments in key markets in which we work. For example, Associate Consultant, George Forsyth, joined a session on political dimensions impacting affordability in the Dutch market. Whilst healthcare costs have been increasing in the Netherlands, this is driven not by increased drug prices or medical costs, but patient volume due to the ageing population. 

George also learned about recent changes in Russia, where he was interested to discover that the new CHQAC center is trying to oversee implementation of formal cost-effectiveness, based on a threshold of up to 2 million Roubles (approx. $25,000 USD) for inclusion on the EDL (Essential Drug List).

Reflecting her focus on emerging markets, Rachel Howard also joined a number of sessions exploring access issues in LMICs. One of these looked at market access conditions and healthcare for the Far East and Australasia. This region is home to 60% of the world’s over- 60 population, and many countries see a high proportion of patients spending over 10% of their household income on healthcare. There is therefore both a high need and high opportunity for innovative pathways to improve market access. Alternative approaches to allow access where innovative contracting cannot easily be implemented due to lack of information, such as infrastructure investments and portfolio solutions, were discussed.

Concluding thoughts

Just as market access at its core relies on making trade-offs, this year’s conference itself came with its own bittersweet trade off. On one hand, we missed the vibrant setting and networking opportunities of Amsterdam, where the conference was originally due to have been held, and we very much hope to have the chance to attend in person again once all of this is over. However, by having access to the sessions virtually, we welcomed the opportunity for more of our team to join and keep up-to-date with the latest thought leadership and developments on key topics within pricing and market access.