Why I’m Bullish on European Market Access: The Social Contract (Part 2 of 4)
As many of us in the market access community gather this week in Amsterdam for the EPA Congress, I’m sharing some thoughts on why I’m optimistic about access in Europe. Last week I wrote about how the JCA is providing an opening for innovative leaders to change how we work on access. Today I want to share how GLP-1s are likewise providing an opening for adjustments in the social contract of access in Europe.
Out-of-Pocket
The new GLP-1 Agonists are turning out to be quite promising for addressing diabetes, obesity and other chronic conditions. So promising that many patients in Europe are willing to pay out of pocket for these treatments rather than wait for access for their indications through traditional reimbursement channels.
In Europe there’s a general expectation that medicines are reimbursed by either private or public insurance. Could that be changing? In addition to creating initial demand shock in the system, this trend of patients paying out of pocket for faster access could continue and expand as private payment for these therapies and others that can be paid for by individuals open up budgets for the more expensive cell and gene therapies that can really only be financed through insurance and other mechanisms of social solidarity.
This opens some delicate questions. Should those of us who work in market access actively support a scenario where thousand-euro drugs are paid out of pocket so that million-euro cures can be more readily reimbursed; whether actively, or passively through our prioritization of access activities? And how would we handle the concerning inequity issues that result, especially in societies with a tradition of social solidarity?
Or should we take the patient prioritization of these treatments as an indicator of their value to society and thereby use every available economic lever in our arsenal to open the floodgates to reimbursing these obesity drugs for all relevant indications? What adjustments to pricing would warrant this, or should this be viewed not simply as reimbursement in the traditional sense but almost an “industrial policy” to accelerate positive health effects? Could we count on the budget spend being replenished over time by the macro effects of their outcome or are those benefits too far out? How should we balance any unknown risks with known benefits? These are not easy questions to resolve.
A potentially virtuous cycle
This brings me to a second mechanism of economic action of these drugs on the social contract. When it comes to healthcare budgets, what direct impact might these drugs have on the ongoing cost of treating chronic conditions? This impact could open the budget for the new truly expensive therapies and cures, which may further reduce the disease burden for life changing therapies in a virtuous cycle.
Of course one can certainly argue that the reason that drugs are needed to treat obesity is an indication the overall system is broken: the food system, the marketing system around it, has contributed to what is now a global epidemic. These are important issues, no doubt. But within the limited scope of market access, these arguments are largely orthogonal to our access decisions. Regardless of how we got to the current situation, if we can reduce obesity, the lives saved and virtuous impact on the burden of disease opens up real possibilities that would not otherwise be available to us.
Why Europe
And that gets to why I’m really quite bullish about access in Europe and similar markets. In the European healthcare model, long-term benefits to patients and the resulting economic growth are generally counted by health systems as a “win.” As such, just as the increase of chronic disease in recent decades has had a stagnating effect on the health system’s flexibility to invest in new science, so reducing our reliance on managing chronic conditions can provide new resources for additional cures and the new cell and gene therapies. As this rebalancing of the portfolio of health interventions redirects money from disease management toward cures, access could become even faster in Europe than elsewhere — provided the infrastructure and other details are in place to support this.
“Fast access in Europe?” Sounds like a pipe dream… almost like a “pill for obesity.” But what has been difficult to imagine a few years ago is now within reach scientifically, and likewise, despite recent market access challenges and failures, I expect those creating the new science of medicine will soon find European payers more aligned than they have expected — provided the details can be managed. In the next few days I’ll be sharing more thoughts on how those details are being addressed through changes in leverage within and between companies and payers, and specific ways in which technology can accelerate this transformation. More soon…