Value Based Drug Reimbursement Gavura


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Part of a panel presentation at the CADTH Symposium in April 2011:

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Value Based Drug Reimbursement Gavura

  1. 1. Value-Based Drug Reimbursement:Do we want it? Do we already have it?Presented by:Scott Gavura, BScPhm, MBAPresented at:CADTH Symposium, VancouverApril 5, 2011
  2. 2. VBR has UK Origins• Pharmaceutical Price Regulation Scheme (PPRS) no caps on pricing, only profit: “profit control” Agreement between Dep’t of Health and industry Concerns about unjustified high prices and a scheme that did not promote innovation or access• Value-Based Pricing proposed in report from Office of Fair Trading on the PPRS• So how do we define value and measure value? Value to whom? 2
  3. 3. Value-based Objectives: pricing: a. Better patient a mechanism for outcomesensuring patients can b. Greater innovation get access to the c. Broader and moremedicines they need transparent by linking the prices assessment the NHS pays drug d. Better value-for-providers to the value money for the NHS of the treatment. 3
  4. 4. • Basic threshold QALY • Which perspective? Burden of • Unmet needs Illness • Severity of disease Therapeutic • Degree of innovation?Improvement • Comparator? Societal Benefits • How measured? 4
  5. 5. NICE’s proposal: 5
  6. 6. Other Policy Implications• Pricing for existing drugs?• NICE will continue to play a role Own response to consultation suggests new model for review• Non-transparent pricing to maintain world pricing comparators• Ongoing evaluations, not just pre-funding 6
  7. 7. Germany: The end of free pricing• Arzneimittelmarktneuordnungsgesetz (AMNOG) Pricing must now be justified based on comparative evaluations• Value dossier must be submitted within 3 months of launch• Does drug offer incremental benefit? No: Reimbursement referenced to comparator, or price negotiations Yes: Continued reimbursement x 12 months, LT negotiation – Price reduction could be administered via rebates – ? Retroactive pricing 7
  8. 8. Other aspects of value• Innovation: We want it, but do we want to pay for it? How much (if any) should be reflected in acquisition cost? Unmet need vs. “me-too” treatments• Accounting for future generics Biologics vs. non-biologics, and impact of biosimilars 8
  9. 9. Today’s Panel• Scott Gavura, BScPhm, MBA• David Shum, BScPhm, PharmD, MBA• Jeffrey Hoch, PhD• Kevin Wilson, BSP, MBA 9
  10. 10. The questions to our panel:• Is VBR a good thing for payors?• Is VBR just a fancy name for “discounting”?• Can VBR drive the production of (truly) innovative drugs?• Does valuing drugs based only on cost / QALY lead to a divergence from societal value statements?• Can we achieve VBR in an era of increasingly personalized therapies?• Are Canadian public payors already achieving VBR? 10 Where does that leave private and cash-payers?
  11. 11. Value-Based Drug Reimbursement:Do we want it? Do we already have it?Presented by:Scott Gavura, BScPhm, MBAscott.gavura@cancercare.on.caPresented at:CADTH Symposium, VancouverApril 5, 2011
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