The New Normal
The pharma industry is on the cusp of a new dawn, but what does it look like?
The ancient Greek philosopher Heraclitus believed that the world is governed by a constant state of change. He said: “No man ever steps in the same river twice, for it's not the same river and he's not the same man.” For Heraclitus, living in a constant state of flux encourages us to always look at things anew, and to reject the dogma that comes with established practice.
This rings as true today as it did in the 5th century BCE. New laws are passed to reflect shifting social attitudes, new ideas lead to new inventions, and science has proven that even our cells regenerate – in strictly biological terms, we are never the same person.
The pharma industry seems to be embracing the ideals of impermanence, finding new ways to evolve, define its value and ultimately usher in a ‘new normal’.
But what does this new normal look like? “At Novartis, we feel this new normal is based on two pillars,” says Fabrice Chouraqui, President, U.S. Novartis.
“The first is about acknowledging the healthcare system is complex and not transparent, which leads to aggressive formulary management and a very difficult system for providers and patients to navigate.
For example, there is great disparity between list price and net price, between the price that is visible to the public and the price at which payers buy the drug, which remains an abiding issue, laments Chouraqui.
“The second pillar is that pharmaceutical innovations are transforming from small molecules that reach large populations, to an era of targeting high unmet medical need and small specialty conditions where the cost is higher, but the impact of medicines is transformative.”
The ongoing move to value-based pricing agreements will bridge this disconnect, he predicts.
Novartis has already made inroads in this space. A recent example being its first Car-T cell therapy Kymriah - a blood cancer drug designed to treat paediatric and young adult patients. Novartis won't charge for Kymriah if a patient does not respond by the end of the first month of the treatment.
For Chouraqui, outcomes-based agreements encourage pharma to see the forest for the trees. “The true value of a treatment is looking at it holistically in a fair and balanced way, using transparent methodologies that take into consideration the value it brings to different players in the healthcare system.”
Engaging the relevant stakeholders and aligning everyone’s goals to ensure patients receive the best possible treatment is an arduous challenge, but outcomes-based agreements are a decisive step in the right direction, he affirms.
Chouraqui identifies four key metrics which can be used to determine the value of a drug. “I see shrinking a tumour for example as the clinical value of a treatment, the patient value comes from improving the quality of life for patients; the health system's value can be illustrated through reducing the rate of rehospitalisation, but there is also the societal value such as allowing the patient or even a caregiver to return to work.”
Chouraqui also champions the rise of HTAs in this space. “I believe we could better leverage health technology assessments. As long as we can come up with methodologies that are transparent, which are fair and balanced, they could be really be great in helping to assess the value and simplify the system. He continues. “It is reasonable to think that if a drug value is being assessed scrupulously by an independent party, that should be an incentive for payers to cover that drug, and then we could lift a lot of complexity for payers and patients navigating the system. I think this would be a win for everyone.”
Pharma cannot maintain this momentum alone however, stresses Chouraqui.“The healthcare system is so complex, not a single player will be able to create efficiency, everyone must work in collaboration and be animated with the unique purpose of improving patient care. That should be the driver, and everyone should be judged by that.”
Fabrice will be presenting his insights at the eyeforpharma Philidelphia 2018 event in April.
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