Payers can improve risk-sharing approaches for expensive therapies and technology

Wolters Kluwer Pharma SolutionsMar 25 2010

Wolters Kluwer Pharma Solutions, Inc., a leading provider of scientific information and analytics to the pharmaceutical and biotech fields, announced today that it has published the collective recommendations of an international team of healthcare experts on how payers can improve their risk-sharing approaches for expensive new therapies and technology.

Participants of the 2009 Banff Summit on evidence development, held in Calgary, Canada, reached a consensus about how to better evaluate and design payer reimbursement mechanisms for high-cost medical treatments.  Participants included leading risk-sharing experts from Australia, Canada, the U.K. and the U.S., all who were signatories on a consensus statement.  The resulting guidelines were published for the first time in the Adis journal PharmacoEconomics (2010, Vol. 28, No. 2).

"Health decision makers across the globe, such as Medicare in the U.S. and NICE in the U.K., are increasingly looking at ways of managing the uncertainty that often surrounds the therapeutic and economic value of new prescription drugs," said Christopher Carswell, Editor, PharmacoEconomics.  "Risk-sharing schemes are one way to allow reimbursement of expensive drugs and limit the cost burden on payers."

There is often much discussion between payers, manufacturers and patient advocacy groups about the reimbursement of high cost novel drugs used in chronic conditions such as cancer, multiple sclerosis and other debilitating diseases.  Payers are often under huge pressure to subsidize these treatments.  Coverage with evidence development, or risk sharing, as it is commonly called, allows payers to make these treatments available by sharing the financial risk with the manufacturer.  The topic of risk sharing is closely tied to the comparative effectiveness healthcare reforms going through the U.S. legislature.  One bill calls for a specific center to be set up within Medicare to devise innovative approaches to risk sharing.

This special issue of PharmacoEconomics is devoted entirely to the topic of "access with evidence development" and is intended to help "manage the tension between funding new but expensive treatments and obtaining value."

According to Carswell, the new guidelines and checklist published in the issue could easily become a template for designing future risk-sharing schemes.  It is essential reading for all stakeholders affected by risk-sharing, including manufacturers, patient and advocacy organizations, decision makers and the health insurance industry.

The benchmark journal on the applications of pharmacoeconomics and quality-of-life assessment, PharmacoEconomics is an invaluable source of applied original research and educational material for the healthcare decision maker.  The journal is dedicated to the clear communication of complex pharmacoeconomic issues related to patient care and drug utilization.