Campbell Alliance, an inVentiv Health company and an industry leader in biopharmaceutical and medical technology consulting, today announced the release of a landmark study titled Turning Tides: Trends in Oncology Market Access. The study examines the high cost of cancer care and the unique market access challenges faced by biopharmaceutical companies as a result.
To better understand these challenges, Campbell Alliance conducted an in-depth analysis of the three market trends of greatest concern to the biopharmaceutical industry:
Campbell Alliance fielded an online survey in April 2012 to gather perspectives on oncology trends from respondents representing 38 managed care health plans and 181 million covered lives in the US. In addition, Campbell Alliance conducted telephone interviews in May 2012 with respondents representing 15 community practices to gather their perspectives. This in-depth primary research was combined with marketplace surveillance through secondary research and hands-on industry experience to provide a comprehensive look at the key drivers and barriers associated with each of these trends.
“Very few people understand these very important trends to the depth that we were able to with this study,” said Lujing Wang, Practice Area Leader at Campbell Alliance and a co-author of the study. “With primary and secondary research, we are able to offer a complete picture of the different moving pieces driving these topics and can provide actionable recommendations for positioning a market access strategy to best capitalize on opportunities in today’s oncology environment.”
One of the most important trends impacting the oncology market is the increasing shift in cancer drug spending to hospitals, many of which have access to 340B pricing that limits the cost of drugs to eligible institutions. For pharmaceutical marketers, hospitals represent a very different sales channel in terms of the system structure, stakeholder incentives, and selling messages. Drugmakers will need to look for ways to mitigate site-of-care shifts by addressing the financial concerns of community oncologists.
The report is particularly timely as political, socioeconomic, and regulatory forces accelerate shifts in site of care and provider consolidation. The threat of sequestration is top of mind for many market access professionals, as Medicare reimbursement for Part B drugs is due to be reduced to ASP+4% beginning January 2, 2013, unless Congress intervenes.
“The Budget Control Act mandated that if Congress can’t slash our spending, there’s going to be an automatic cut across the board. What that means in healthcare is a 2% reduction in physician payments,” said Terry Tao, a Practice Executive at Campbell Alliance and a co-author of the study. “In light of the January 2 reimbursement change, companies will want to do a better job of targeting hospitals that don’t currently participate in 340B programs. It’s not just how to sell to hospitals, it’s how to target and sell to hospitals.”
Another important trend is the increased use of oral oncolytics in cancer treatment, which confers different advantages and disadvantages to patients, providers, and payers. Patients face a significant co-pay burden with oral drugs, increasing the need for drugmakers to offer patient assistance programs. Meanwhile, physicians are losing buy-and-bill opportunities with oral drugs, putting a squeeze on their margins. For drugmakers, this represents an opportunity to help physicians find ways to reduce their reliance on buy-and-bill profits and diversify their revenue stream. Finally, oral drugs are easier for payers to manage than traditional oncology products, allowing them to employ tiered copayments and aggressive restrictions similar to those employed around small molecule brands. Drugmakers will need to optimize their investment in patient assistance programs, help physicians maintain their economic viability, and consider payer contracting strategies to defend or improve access.
Payers are looking for game changers to save them a meaningful amount of money. This has led them to look into payment reform and the use of clinical pathways to restrict choice—the third trend examined in the Campbell Alliance study. According to the study, the vast majority of payers plan to increase their use of biomarker testing to prospectively identify likely responders where indicated, as a means to ensure appropriate use and fulfill their need for budget predictability. Meanwhile, most commercial health plans require prior authorization re-certification and often ask for documentation of patient response to therapy at the time of re-certification. Nearly all payers surveyed require documentation of patient response to therapy.
In light of these trends, drugmakers must ensure their target product profile does not inadvertently lead to a label that incurs highly restrictive payer management, and they must develop a compelling economic value proposition to ensure pathway inclusion.
For further information on Turning Tides: Trends in Oncology Market Access
including access to the full study results, please visit the Campbell Alliance website at http://www.campbellalliance.com/TurningTides
About Campbell Alliance
Campbell Alliance is the Consulting business segment of inVentiv Health, a leading global provider of best-in-class clinical, commercial, and consulting services to companies seeking to accelerate performance. Campbell Alliance is an industry leader in biopharmaceutical and medical technology consulting. The firm's clients include all of the world's top-20 pharmaceutical companies, as well as numerous emerging and midsize firms. Campbell Alliance is organized into practice areas, each specializing in a critical industry function: Brand Management, Clinical Development, Commercial Effectiveness, Corporate Development, Medical Affairs, and Pricing and Market Access. From its locations in New York City; Raleigh, NC; Parsippany, NJ; Somerset, NJ; Newtown, PA; Los Angeles; San Francisco; Chicago; Boston; Philadelphia; London; and Zug, Switzerland, the firm serves clients throughout North America, Europe, and Japan. For more information on Campbell Alliance, please visit http://www.campbellalliance.com
About inVentiv Health
inVentiv Health, Inc. is a leading global provider of best-in-class clinical, commercial and consulting services to companies seeking to accelerate performance. inVentiv’s client roster includes more than 550 pharmaceutical, biotech and life sciences companies. With 13,000 employees in 40 countries, inVentiv rapidly transforms promising ideas into commercial reality. inVentiv Health Inc. is privately owned by inVentiv Group Holdings Inc., an organization sponsored by affiliates of Thomas H. Lee Partners, L.P., Liberty Lane Partners and members of the inVentiv management team. For more information, visit http://www.inventivhealth.com
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