New strategies for managing drug spend: RA, Cancer, Hep C
Lelinski outlines four game-changers in managing specialty drugs:
1. Diverse, big data sets. These enable predictive targeting in niche specialty diseases, by integrating more data of different types for the exact same patient.
2. Deep, sublevel analytics. These provide more specific subpopulation levels to determine inappropriate use; high clinician variability; real-world safety issues; and poor adherence.
3. Integrated systems. Integrated provider-payer systems are uniquely positioned to lead the way on new, collaborative business models.
4. Biopharma embracing pay for value. Drug pricing is best disrupted at the edges; biopharma must commit to pay for value with the rest of the healthcare ecosystem.
Taking a look at hepatitis C, Lelinski says it is important to understand subpopulations. “If you know the economic impact of a decision before it is made, you can create an approach for patients so that prior authorization is not needed; most hepatitis drugs are approved anyway,” he says.
Lelinski sees oncology as an area with few competitors but several options and alternatives—too many for clinicians to process. “Decision support is needed for better outcomes linked to insurance and population health, along with more partnerships between plans and clinicians, including incentivizing clinicians because they are taking a risk.
“As we go to scale, one therapeutic area at a time, we will see 15% to 20% specialty drug trend lines dropping to single-digit growth without stifling new drug innovation,” Lelinski says. “We will pay only for the value we receive.”