Earlier this month a new initiative was announced to encourage oncologists to discuss the price and relative value of cancer medicines with their patients. No, this was not driven by executive fiat as part of the ACA, nor is it the brainchild of an insurance carrier. Instead, it comes from the American Society of Clinical Oncologists, or ASCO, the professional organization for oncologists and publisher of the Journal of Clinical Oncology, among other titles.
ASCO has formed working groups that will weigh efficacy, side effects and price to help better define the value of oncology medicines. Initially these groups will look at treatments for advanced lung and prostate cancer and for multiple myeloma, said Richard Schilsky, the group’s chief medical officer.
This comes a little less than a year after Scott Ramsey from the Fred Hutchinson Cancer Research Center in Seattle published a study suggesting that individuals with a cancer diagnosis were 2.5 times more likely to file for bankruptcy compared to a matched control group.
Not unlike hepatitis C, the price of therapy in oncology is a hot topic, as 11 of the 12 cancer drugs approved by the FDA in 2012 were priced at more than $100,000 per year.
To date, ASCO and another group, the National Comprehensive Cancer Network (NCCN), have published treatment guidelines that payers use as the basis for reimbursement coverage of cancer drugs, but these guidelines have been value-agnostic, meaning the price of the drug has had little or nothing to do with strong category recommendations. ASCO’s move could change this.
So how could this impact our clients’ business?
· Pharma has traditionally had to defend ultra-premium pricing only to payers, who, in many cases, were/are legally obligated to cover the costs, at least for Medicare/Medicaid patients. Broadening this conversation to include HCPs and patients could affect overall product positioning, messaging and channel strategy.
· Manufacturers need to rethink how they approach the value section of the AMCP dossier as they submit these to payers as the way payers (public or private) are assessing value will change. The dossier must also be consistent with value messages to non-payer audiences.
· With compensation models for oncologists already shifting from “buy and bill” to “pay for quality,” these ASCO value ratings could further aid in the rapid adoption of biosimilars and generic targeted small molecules that will begin hitting the market in the next few years.
· To the ire of many payers, pharma has been able to mitigate some financial barriers to obtaining therapy through the use of co-pay cards and other assistance programs. If the conversation turns from out-of-pocket costs to “costs to society,” demonstrating meaningful value will be of paramount importance to brands.
· Dialogue studies in this category suggest sometimes broken dialogue between HCPs, cancer patients, and their caregivers. Layering on a discussion about the value of a drug could add to the confusion. As oncologists experiment with this new value lexicon, it could create an opportunity for brands to take a leadership role in framing the value discussion.
Historically in the US, positioning a drug on “value” has been akin to admitting your brand does not offer a meaningful advantage over existing therapy options. Will this nascent movement result in opportunities for value-based oncology brands? Only time will tell, but in the meantime rethinking how we articulate value is more important than ever.
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