Payers to pharma: Here’s what we’re missing in hep C drugs
Payers have unmet needs in the changing hepatitis C (HCV) space, according to a new survey.
The survey, from Precision for Value, highlights what can be done in order to encourage payers to ease coverage policies for these drugs in the next wave of HCV treatment.
“Payer priorities are shifting to wanting agents that address difficult to treat HCV patients including those with less common genotypes and patients failing prior therapy,” says Jeremy Schafer, PharmD, MBA, senior vice president, director specialty solutions at Precision for Value.
The unmet needs cited by payers in the survey included addressing prior treatment failures (64%), overcoming resistance (52%), shortening the duration of therapy (40%). To ease coverage, payers need two things: reduced costs and proven outcomes.
Real-world outcomes a must
The survey found that 48% of payers wanted to see a real-world outcomes study. “Payers really want to see if the real-world outcomes have approached the clinical trials,” according to Schafer. “Payers spend significant money on HCV treatments but may lack the other side of the story, what are they getting? Are patients staying adherent? Are they being cured? If so, does the cure rate match what was seen in clinical trials? Answering these questions for payers may make them more comfortable with broader coverage. Unlike some other specialty disease states, HCV presents a specialty category where the outcome is well defined and trackable.”
Payers could partner with health systems or even specialty pharmacies to obtain information on cure rates or need for retreatment, Schafer advises. Manufacturers could also play a role by conducting real-world outcome studies to track the cure rates of patients treated on their product(s).
Cost will continue to be an issue as well, according to the survey. More than two-thirds of payers saying current rebate is an integral factor when determining whether to switch a preferred therapy. In fact, nearly half of payers believed that if a product wanted to displace the current preferred agent, the net cost savings of the new product would need to be at least 30%.
“Even as utilization has plateaued or dropped, payers are guarded because HCV continues to be a cost driver,” Schafer says. “Aggressive contracting with an outcomes component where appropriate, may ease access as well. Now that the category has matured, more payers want to see pharma back up their claims with outcomes data and even outcomes based contracts.”
HCV continues to be a prevalent disease with only a fraction of the 2.7 to 3.9 million infected patients in the United States having received therapy, according to Schafer. The CDC recommends testing for all Americans born between 1945 and 1965 meaning that there could still be many patients waiting for therapy.