Pharma and payers not aligned, says survey

A new survey has found that pharmaceutical companies and payers are not seeing eye to eye.

The report was conducted by the advisory firm EY, and is called "EY Progressions 2014: Navigating the payer landscape." In brief, they found that accountable care organizations (ACOs) and payers have distinct criteria for what makes a drug worthwhile, and pharmaceutical companies are not recognizing unique payer communication needs.

EY conducted the survey, which included US and European payer organizations and pharmaceutical companies, in order to better understand the complex and changing payer landscape.

They found that overall, payers are more focused on cost containment than on outcomes-based approaches to containing costs. Even though prescription drugs only amount to approximately 10% of healthcare spending, payers also see drug costs as their biggest challenge.

Other findings were that while pharmaceutical companies are generally well aligned with the data needs of payers, one area of disconnect is clinical trial data. Payers want to view data from comparative trials, but the pharmaceutical companies are most invested in placebo-controlled trials. Payers also appear to be preoccupied with implementing challenges related to healthcare reforms. While they can probably use some help in this, they do not seem to trust the pharmaceutical industry to have the required impartiality.

A vast majority of payers (88%) reported that drug prices are a major reason for the rising costs of healthcare. Conversely, less than half (42%) of surveyed industry insiders agreed with that premise.

The researchers were able to find some overlap between payers and treatment decision-makers. While payers were open to new drugs, the label "new" has to be supported by robust information that demonstrated a clear advantage over products that were already available on the market. Payers were also rather circumspect about what actually qualifies as innovation. Only 20% of respondents thought that “new pharma products are significantly differentiated from standard-of-care."

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