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Trends to Watch through 2023: A new era for value-based pricing agreements
Mar 21, 2022
As we launch into 2022, it’s time for our stakeholders to look ahead and begin making and adjusting their yearly goals. It will be important to explore what trends in pharma are developing and how they may impact those working in the industry. In this blog series, we will explore the top seven trends we see emerging in 2022 and 2023, and how our customers should respond.
In this ever evolving and expanding market access ecosystem, value-based pricing agreements represent an important opportunity for the pharmaceutical industry.
A new era for value-based pricing agreements
Over the past 20 years, there have been approximately 65 drugs launched that cost more than an annual treatment cost of $200,000. The velocity of drug launches that fit this price threshold has increased over the past five years. An examination of the current drug pipeline indicates that we could see the number of high-cost treatments double over the next five years. As high-cost drugs come to the market with increasing regularity, the question of how these drugs will be paid for is growing louder.
How will an already complex health system pay for the doubling of the number of high-cost orphan disease and oncology products that we expect to see coming into the market over the next five years? Value-based contracting will be a very important option for stakeholders to turn to as it will give a mechanism to ensure that needy patients have access to these higher-cost drugs and that they are used appropriately.
With novel curative drugs, manufacturers may have the opportunity to enter into a value-based agreement and commit to the efficacy and value of their product. One challenge facing these agreements in today’s market is the Medicaid best price implication. Let’s say that a manufacturer were to agree to an access contract that their drug works or it is free. They may be very confident based upon the clinical trials that the product is efficacious and that broad patient populations may benefit. However, if there is a single instance where the product does not work, the new best price in the market is now free. As such, the entire Medicaid channel would now have access to the drug at no cost. This financial hurdle presented in the current regulatory environment has acted as a significant disincentive to entering into value-based agreements.
However, recent new rules may soon make it easier for willing stakeholders to enter into novel access agreements. At the end of 2020, the Trump administration issued a new Centers for Medicare and Medicaid Services (CMS) rule that will create a second mechanism by which a discount for value-based agreements will be excluded from best price. If this rule gets published, and takes effect, it will remove a significant statutory barrier and we could see a new age of value-based agreements emerge.
In our next blog, we will explore health equity.
Top Issues for Pharma to Watch in 2022 and 2023
Coming out of the global COVID-19 pandemic, the future holds both opportunity and increased complexity for the pharmaceutical industry. There are many important issues for pharma to watch in the near future as economic factors will continue to put pressure on revenue and margins. Seven important issues for pharma to watch in 2022 and 2023 that focus on policy, payer, and patients are explored during this webinar.