Partnerships between healthcare insurers and pharmaceutical companies promote real-world value

PwC's Health Research Institute (HRI) reports that market forces are driving new sector collaborations– pairing traditional drug makers with insurers, health systems, patient groups and technology firms – to maximize real-world value and health outcomes. Partnerships are leveraging personal health information as the newest currency in drug development and commercialization.

In the"21st Century Pharmaceutical Collaboration: The Value Convergence" report, HRI examines stakeholders who are prioritizing optimal patient outcomes over conflicting business incentives and industry obstacles, such as compliance issues and an unwillingness to share data, changing how efficacy is measured and usage decisions are made.

Trending market factors such as rising drug costs (particularly due to the entry of specialty drugs), increased competition in key therapeutic areas, inefficient and outdated clinical trial models and evolving provider regulations and incentives are shifting the spotlight to patient health outcomes and its relationship to value, reforming traditional methods of drug evaluation in the New Health Economy. For example, sixty-one percent of pharmaceutical executives attribute a high level of importance to real world data.

"The new environment has patients, health insurers and pharmacy benefit managers (PBMs) determining the value of therapies in the real world," said Douglas Strang, global pharmaceuticals and life sciences advisory leader, PwC. "Partnerships between healthcare insurers and pharmaceutical companies that promote real-world value are becoming the new measure of effectiveness, versus reliance on traditional measures."

Four key stakeholders to watch:

  • Government agencies and lawmakers are increasingly committed to industry collaborations, demonstrated by the proposed 21st Century Cures Act and the collaboration roadmap produced by the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator
  • Emboldened health insurers and pharmacy benefit managers are consolidating to protect their drug margins, enabling aggressive contracting and drug rebates
  • New entrants are filling evidence gaps by integrating consumer technology into the delivery of care
  • Consumer expectations and patient advocacy groups are pushing for further inclusion in the drug development and review process

Personal health information is the new currency of drug development and commercialization

New technology is accelerating the pace of innovation in biopharmaceuticals by democratizing access to data and empowering consumers to manage their health. Companies such as 23andMe and Pfizer are using genetic databases to shape and speed clinical trials as consumers are becoming increasingly proactive about participating.

"Building technology into the drug development model to provide real-world evidence rather than the current system of self-reporting is a new risk pharmaceutical companies need to take to create the opportunity for competitive advantage and prove drugs have value to key decision makers like patients, payers and providers," said Mike Swanick, global pharmaceuticals and life sciences leader, PwC.

New entrants are helping to fill evidence gaps

Companies such as Biogen Idec, Fitbit and PatientsLikeMe are leading the way, aiming to further integrate patient experience into care for chronic conditions, drug development and potentially identify remaining unmet needs. The report notes that the ability to access and communicate targeted, relevant data is key to demonstrating value. Data-sharing across organizations is critical in the creation of personalized medications for specific populations to ultimately derive additional product value.

Key implications for pharmaceutical and life science companies

  • Leveraging the strengths of patient advocacy organizations such as the Chordoma Foundation can expedite recruitment and promote retention in clinical studies
  • Investing in pilot programs in collaboration with clinicians and tech companies can improve care management, promote medication adherence and lower the total cost of care
  • Collaborating with insurers and health systems provides perspective and access to patient data used for coverage decisions – as the HHS aims to tie 85 percent of Medicare payments to value by 2016
  • Embracing patients as consumers may be beneficial as they will more freely contribute their data
  • Working with patient data as regulations evolve will likely deliver a competitive advantage as regulators are exploring new ways to integrate patient experiences into drug review decisions

SOURCE PwC US

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