- Jul 2018
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europepmc.org europepmc.org
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On 2015 Oct 16, Andrea Messori commented:
How to manage the price of the newest expensive agents approved for HCV therapy? Pharmaceutical firms do not adopt the same policies across different countries and different regions
by Andrea Messori, PharmD, Sabrina Trippoli, PharmD, Claudio Marinai, Pharm D
HTA Unit, Tuscany Region, ESTAR, Regional Health Service, 50100 Firenze, Italy
In managing the price of the newest expensive agents approved for HCV therapy, Scripts (the largest pharmacy benefit manager in the US) was successful in fostering the competition between Abbvie and Gilead. In particular, Abbvie accepted an exchange of more prescriptions for price rebates, and so Scripts decided to cover Viekira Pak for the majority of HCV patients and restricted the coverage of Gilead products only under certain exceptions (1).
While Wilensky (1) emphasizes that this strategy based on competition in prices can be an effective way of reducing the cost of these expensive treatments, other experiences in this field have not been successful and therefore deserve to be mentioned. In May 2015, the Tuscany region of Italy undertook a competitive tender scheme aimed at the prescriptions for 18,000 HCV patients of our region (those without cirrhosis) (2) in which both Abbvie and Gilead were expected to participate. In fact, at national level the majority of reimbursed treatments for HCV (currently restricted essentially to patients with cirrhosis) are those based on the products of Gilead and Abbvie. Surprisingly enough, Gilead did not participate in this tender while Abbvie offered their product with no substantial price rebate thus leading to the failure of the Tuscan experience in fostering more prescriptions for price rebates. This is probably because of the reluctance of these two pharmaceutical firms to accept local agreements in which the nominal price of their products is explicitly reduced.
On the other hand, at national level both Gilead and Abbvie have accepted a price-volume reimbursement agreement with our national Medicines Agency (AIFA) according to which the drug prices are progressively subjected to very substantial price rebates (up to 80%) as the number of treated patients increases (3-5). One reason why the two companies have accepted this national agreement is that the agreement has been kept confidential, and so the nominal values of these discounted prices have remained unknown and have not become a reference price for other jurisdictions.
In conclusion, to manage sustainability in this field, payers of Western countries and national health systems have different tools of procurement and reimbursement at their disposal, but choosing the best strategy is a difficult task because pharmaceutical firms do not adopt the same policies across different countries and different regions.
References
Wilensky G. A New Focus on Prescription Drug Spending. JAMA 2015;314(5):440-441.
Brunetto MR, De Luca A, Messori A, Zignego AL. Reducing the price of new hepatitis C drugs in the Tuscany region of Italy. BMJ 2015;350:h3363 doi: 10.1136/bmj.h3363 (Published 24 June 2015), available at http://bmj.com/cgi/content/full/bmj.h3363?ijkey=xYS3zhzXoox8A8t&keytype=ref
Messori A. Newest treatments for hepatitis C: how can we manage sustainability? Clin Infect Dis. 2015 Aug pii: civ667. [Epub ahead of print], preprint available at http://www.osservatorioinnovazione.net/papers/cid2015pricing.pdf
Messori A. Managing the high cost of innovative drugs: anti-cancer agents vs direct-acting antivirals for hepatitis C (Comment posted 2 April 2015), Ann Intern Med 2015, available at http://annals.org/article.aspx?articleid=2212249#tab
Quotidiano Sanità Website. “Epatite C. Pani (Aifa) al Senato: Con accordi Aifa risparmi per 2,5 miliardi in due anni. Ma c’è troppo divario tra le Regioni”. http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=30276 , accessed 30 July 2015
This comment, imported by Hypothesis from PubMed Commons, is licensed under CC BY.
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- Feb 2018
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europepmc.org europepmc.org
-
On 2015 Oct 16, Andrea Messori commented:
How to manage the price of the newest expensive agents approved for HCV therapy? Pharmaceutical firms do not adopt the same policies across different countries and different regions
by Andrea Messori, PharmD, Sabrina Trippoli, PharmD, Claudio Marinai, Pharm D
HTA Unit, Tuscany Region, ESTAR, Regional Health Service, 50100 Firenze, Italy
In managing the price of the newest expensive agents approved for HCV therapy, Scripts (the largest pharmacy benefit manager in the US) was successful in fostering the competition between Abbvie and Gilead. In particular, Abbvie accepted an exchange of more prescriptions for price rebates, and so Scripts decided to cover Viekira Pak for the majority of HCV patients and restricted the coverage of Gilead products only under certain exceptions (1).
While Wilensky (1) emphasizes that this strategy based on competition in prices can be an effective way of reducing the cost of these expensive treatments, other experiences in this field have not been successful and therefore deserve to be mentioned. In May 2015, the Tuscany region of Italy undertook a competitive tender scheme aimed at the prescriptions for 18,000 HCV patients of our region (those without cirrhosis) (2) in which both Abbvie and Gilead were expected to participate. In fact, at national level the majority of reimbursed treatments for HCV (currently restricted essentially to patients with cirrhosis) are those based on the products of Gilead and Abbvie. Surprisingly enough, Gilead did not participate in this tender while Abbvie offered their product with no substantial price rebate thus leading to the failure of the Tuscan experience in fostering more prescriptions for price rebates. This is probably because of the reluctance of these two pharmaceutical firms to accept local agreements in which the nominal price of their products is explicitly reduced.
On the other hand, at national level both Gilead and Abbvie have accepted a price-volume reimbursement agreement with our national Medicines Agency (AIFA) according to which the drug prices are progressively subjected to very substantial price rebates (up to 80%) as the number of treated patients increases (3-5). One reason why the two companies have accepted this national agreement is that the agreement has been kept confidential, and so the nominal values of these discounted prices have remained unknown and have not become a reference price for other jurisdictions.
In conclusion, to manage sustainability in this field, payers of Western countries and national health systems have different tools of procurement and reimbursement at their disposal, but choosing the best strategy is a difficult task because pharmaceutical firms do not adopt the same policies across different countries and different regions.
References
Wilensky G. A New Focus on Prescription Drug Spending. JAMA 2015;314(5):440-441.
Brunetto MR, De Luca A, Messori A, Zignego AL. Reducing the price of new hepatitis C drugs in the Tuscany region of Italy. BMJ 2015;350:h3363 doi: 10.1136/bmj.h3363 (Published 24 June 2015), available at http://bmj.com/cgi/content/full/bmj.h3363?ijkey=xYS3zhzXoox8A8t&keytype=ref
Messori A. Newest treatments for hepatitis C: how can we manage sustainability? Clin Infect Dis. 2015 Aug pii: civ667. [Epub ahead of print], preprint available at http://www.osservatorioinnovazione.net/papers/cid2015pricing.pdf
Messori A. Managing the high cost of innovative drugs: anti-cancer agents vs direct-acting antivirals for hepatitis C (Comment posted 2 April 2015), Ann Intern Med 2015, available at http://annals.org/article.aspx?articleid=2212249#tab
Quotidiano Sanità Website. “Epatite C. Pani (Aifa) al Senato: Con accordi Aifa risparmi per 2,5 miliardi in due anni. Ma c’è troppo divario tra le Regioni”. http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=30276 , accessed 30 July 2015
This comment, imported by Hypothesis from PubMed Commons, is licensed under CC BY.
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