Technology helps payers and pharma agree access to new therapies earlier, better, faster

Technology for early engagement can help pharma companies and payers co-create a vision of access, helping patients receive new treatments earlier, with manageable budget impact. Here’s how:

In the past, the drugs and the deals needed to get them to market were relatively simple. But the pace of innovation is now ultra rapid, with potential cures turning deadly diseases into manageable conditions.

These genuine innovations require new thinking about how we are going to pay for them as healthcare budgets get ever tighter. These new payment models take time and effort to arrange. That’s why in Europe the average time from regulatory approval to reimbursement approval is now 1.4 years.

Using technology to safely engage on the structure of these agreements before approval allows payers and pharma to do these deals without delaying access. This has advantages for companies, payers and, ultimately, patients:

• Faster Access — Tech-enabled deal planning allows more sophisticated and complete earlier engagement which opens up the possibility of faster access for patients. Deals can be done or almost done by the time therapies are approved as safe and effective.
• Flexibility — With technology tools, various deal scenarios can be explored simultaneously and changes to deal structure can be observed as possible changes in budget impact. If one approach is a nonstarter, then tech-enabled scenario planning provides a time-saving way to identify and negotiate alternative solutions.
• Efficiency — Earlier engagement and faster deal-making releases more time to spend either doing more deals or managing the ones already in place.
• Visibility — Tech-enabled visualisation allows, for example, likely budget impact scenarios to be modelled and communicated more easily, facilitating better budget planning.
• Fewer surprises — Everyone knows what to expect ahead of time, resulting in fewer shocks and much less stress.

Despite potential benefits, early engagement can seem daunting:

• For pharma companies, it may mean “facing the music.” The pricing mantra that carried a company through rounds of financing may encounter difficulties when that company engages with real payer constraints. At the same time, there may be time to navigate those constraints more successfully.
• For payers, especially for government payers, early engagement stretches people out of their comfort zone. There’s a perceived vulnerability in engaging actively with private sector companies that have always been dealt with at arm’s length. Inviting early conversations where in the past this was not “the way it’s done” can be difficult. And opening the purse, even with money-back-guarantees and other innovative payment models, may be difficult no matter how many acceptable scenarios are modelled.
• For both, there’s a fear of “what if I share too much?” Early engagement certainly needs to be handled carefully.

In my colleagues and my work supporting payers and companies with technology for early engagment, we’ve found that three things seem to predict success:

1. Being creative and respectful. Both sides should be ready to explore new approaches with both willingness to be creative and also a respect for the constraints of the other party on the type of deal structure. It also helps to have an understanding that changes to procedures used by healthcare systems take time.

2. Using technology wisely. Technology can be really helpful in both identifying solutions such as visualising budget impact under a variety of deal scenarios and in collaborating by sharing certain aspects of deals and assumptions early on whilst, of course, still keeping some others ‘up your sleeve!’ Here are some other reasons why tech helps: scalability, complexity, confidentiality, security, auditability, streamlining and generally allowing better in-person interactions. It’s not really about the tech itself, it’s about how tech creates, supports and enables better engagement.

3.. Being willing to adapt. Very few jurisdictions incorporate this sort of approach as a matter of standard process today, in part because the technology that allows the safe exchange of this sort of information did not exist previously. It’s really helpful for us all to open ourselves up to the possibility of technology making early engagement safe and beneficial.

My colleagues and I certainly don’t have all the answers, but we are seeing more and more payers, HTA organisations and pharma companies successfully navigate early engagement with promising results. If you have thoughts on this, please feel free to write me at nathan@ccx.tech and I’d be happy to compare notes.