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Market Research Report

Payer Insights: Hepatitis C

Published by FirstWord Product code 314811
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Payer Insights: Hepatitis C
Published: September 26, 2014 Content info:

The race is on for the company that can competitively price treatment regimens, share data on clinical benefit/positioning and support patient initiatives.

‘Payer Insights: Hepatitis C’, based on in-depth interviews with 12 leading healthcare payers in the US, is packed with hard-hitting, candid opinions and advice on how, from their perspective, Pharma can get it right in the future.

Gilead's commercial success with its ground breaking HCV treatment Solvadi has been matched by the opposition of healthcare payers at the cost.

This report gives insights into what US healthcare payers really think about HCV drug pricing, the growing and frighteningly undefined patient population, limited clinical/outcomes data, poor patient adherence and education - and how can industry positively help and respond.

Key Takeaways

  • Learn critical lessons when establishing pricing policies and know which approaches will be welcomed by healthcare payers
  • Assess upcoming combination therapy launches from Gilead, AbbVie, Bristol-Myers Squibb and Merck & Co: how do healthcare payers view these developments in clinical and cost terms?
  • Understand current HCV treatment guidelines and know the critical role they play in healthcare payer decisions
  • Accommodate and negate in your product plans the mechanisms by which payers control reimbursement and access to treatment
  • Understand the sometimes conflicting pressures on Medicaid/private HMOs: how could this affect contract negotiations?
  • Gain competitive advantage by providing better more transparent clinical data to support your product - absolutely critical in a world where there is therapy choice
  • Evaluate payer attitudes to price rebates and discounts as well as examining the challenges risk sharing and outcome based pricing could play

Key Benefits

  • Profile the market dynamics and understand why HCV has become such a contentious area
  • Know the research and product drivers that will impact the sector and usher in a new level of treatment options
  • Appreciate the challenges faced by healthcare payers trying to balance the books and forecast need in the face of an ever growing yet undefined patient population
  • Formulate pricing policies that will give you a competitive edge in a crowded market
  • Establish information and education programmes that use research and “real world” data to support clinical and outcomes claims
  • Understand the challenges of patient adherence and formulate supportive initiatives with healthcare payers to support compliance

Get Answers to Key Questions

  • Which pricing strategies could give you a competitive edge in the crowded HCV market?
  • Diagnostic screening is set to increase: Is it good for patients and bad for economics, and how could it affect you?
  • How could information and education programs utilising trusted and “real world” data be used to better support your clinical and outcomes claims?
  • Which R&D drivers will impact the sector and introduce a new level of treatment options, and when?
  • What practical and commercially beneficial role could industry play in helping patients make sure they take their medicines as directed?

Experts Interviewed

  • Chief Medical Officer, Integrated Health Services Organisation
  • Medical Director, Managed Healthcare Company
  • Medical Policy Development Specialist, Managed Care Organisation
  • Senior Clinical Manager, Pharmacy Benefit Manager
  • Pharmacy Director, Community Health Plan
  • Executive Director, Pharmacy Services, Managed Care Organisation
  • Medical Director, Multi-State Healthcare Organisation (covering Medicaid and Medicare lives)
  • Medical Director, Managed Care Organisation
  • Chief Medical Officer, Managed Care Organisation
  • Executive Vice President, Pharmacy Benefit Manager
  • Pharmacy Director, Managed Care Organisation
  • Pharmacy Director, Pharmacy Benefit Manager

Features of the report

  • Based on primary and in-depth research with senior managers and planners working daily in public/private managed care organisations across the US
  • Includes candid payer opinion that can help shape your plans and modify behaviour
  • Includes comprehensive background information on the HCV market, which puts the comments from payers into context

Update Bulletins Offer Ongoing Benefits

The world of pharma is ever changing and executives must always be up-to-date with new developments that could affect their own products, position and research. That is why FirstWord's guarantee to keep Therapy Trends clients up to date with Update Bulletins offers a real commercial advantage.

Update Bulletins include expert insight and analysis based on FirstWord analyst re-engagement with the KOLs after major events such as product approvals, key data releases and major conferences to deliver the most valuable insights with each update.

  • Your Therapy Trends Report purchase entitles you to receive three Update Bulletins, which are published approximately every three months for 12 months following the report's publication date, September 2014.
  • You will receive a copy of each Update Bulletin once available, which are issued each quarter after the publication date.
Table of Contents
Product Code: 596200278

Table of Contents

Executive summary


Methodology and objectives

Hepatitis C market overview

  • Hepatitis C virus(HCV)
    • Genotypes
    • Disease burden and associated costs
  • Current treatment landscape
  • Guidelines and key recommendations
    • Screening for HCV
    • Treatment guidelines

Pricing, reimbursement and market access(PR & MA) for HCV treatments

  • Reimbursement of current HCV therapies
  • The review process for formulary indusion of new drugs
  • Key influences over reimbursement decision-making
    • Is Medicaid reimbursement decision-making different ?
    • Treatment attributes and reimbursement status
  • Current challenges and opportunities
  • Specific data needs to support decisions
    • Real word data
    • Biomarketer
  • Warehousing in HCV from a payer perspective
  • Future challenges and opportunities on controlling PR & MA
  • Patient compliance and access to therapy
    • Methods of monitoring patient compliance
    • Lifestyle issues and drug abuse
  • Sould Medicaid be able to “carve-out” HCV drug costs?

Perspectives on future drug launches in the HCV market

  • Payer awareness of new pipeline therapies and key concerns
  • Key combination therapies in late-stage development
  • Pricing expectations for new therapies
  • Expectations on contracting (e.g. outcomes based, risk sharing)
  • What payers won't pay for, and where they see value
    • Shorter therapy durations should not be at a premium
    • Preferred regimens may be based on cost

Longer-term perspectives on PR & MA in the US healthcare system

  • The perceived impact on longer-term cost savings
  • Mistakes made by pharma, and key lessons to take foreward
  • Words of advice for pharma companies
  • Impact of HCV on other indications and classes of products

Payers interviewed for this report

  • Current HCV pipeline
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