Washington, DC—Complex partnerships among cancer care stakeholders, including drug manufacturers, are becoming the norm. A panel convened at the Fifth Annual Conference of the Association for Value-Based Cancer Care focused on ways in which pharmaceutical firms can refine their drugs’ value propositions.
Moderating the panel, entitled “The Evolving Value Definition for Oncology Therapeutics,” was Darin T. Rubin, Partner and Managing Director of the Dedham Group.
An understanding of the evolving needs of patients, providers, payers, and other stakeholders is essential for pharma to enhance the value equation for their drugs, said Mr Rubin.
Despite fragmented delivery systems, whether at the community level or at an integrated health system, the patient “is at the core of everything,” said Matt Battin, Head of Integrated Health Systems at Novartis. An effective, well-tolerated cancer therapeutic must be tied to clinically relevant outcomes throughout the patient journey, Mr Battin said.
“With that, there is a recognition that you do not have to do it as a manufacturer independently,” he noted. “If you work cohesively and in collaboration with those individuals who touch the patient along the way, you are in a much better position to deliver care.”
Pharmaceutical companies now routinely support efforts that document real-world resource utilization, care quality, and patient satisfaction. Pharmaceutical manufacturers offer specialty distribution services, nurse-staffed adherence initiatives, support services (clinical and financial) for oncology office personnel and patients, and educational and decision-support materials for patients, providers, employers, and health networks.
The standard of care is moving quickly, especially with respect to molecular diagnostics, said Mr Rubin, but without resources such as decision-support tools and education, the care delivery is inefficient.
“We have successfully empowered patients with cancer [who use our drug] through portals and direct-to-patient communications,” stated Kimberly Freeman, PhD, Director of National Accounts at Boehringer Ingelheim.
Dr Freeman said that helping health systems calculate their appropriate use of molecular testing is almost impossible when electronic medical records (EMRs) are not equipped to handle such data.
“All these value-based metrics require so much from a resource perspective at a hospital or a community practice level,” she said. “How do we all work together to try to overcome that?”
“There is an opportunity to work with the emerging infrastructure of EMRs, as well as big data firms. Today, there are a lot of untapped data; pharma will be able to employ those data tomorrow,” said Robert Hung, MEng, Partner at the Dedham Group.
Specialty pharmacy has a role to provide access to its medications through various distribution channels, said Dr Freeman. “I know many small oncology practices that do not have the luxury of dispensing.…I am very firm in my stance on making sure, as a manufacturer, that we provide access for these medicines to distribution channels,” she said.
Brad Failing, Senior National Account Executive at Genentech, said that Genentech explores opportunities with employers and health plans to improve care coordination, citing the example of a large school district in Florida that hired a care coordinator/navigator in its human resources department to work directly with its patients to assist in care coordination. “Ultimately, they saw a 5% reduction in costs across tumor types within the first year, and, at the same time, vastly improved patient satisfaction,” Mr Failing said.
The roles of care navigator or care coordinator start early, even before the initiation of therapy, said Mr Rubin. “We really have to think about how we engage patients early, inform the providers, and inform the payers about what is driving value,” he said. “Maybe that third-party navigator should reside at the employer.”
Moving into the product–value equation, Mr Battin enumerated ways that manufacturers can surround their drugs with a “high-touch” experience to optimize outcomes, including behavioral approaches to improve patient adherence and medication persistence, and personal and remote patient support along the continuum of care.
“More and more, we are helping manufacturers refine their overall value proposition. I think they are recognizing, much more now than ever, that it is not just about showing that you have an efficacious product that is well-tolerated, but also trying to tie it into some of the quality metrics,” said Bedrick Gadea, PhD, Partner with the Dedham Group. One such metric is resource utilization, he noted.
With some specialty drugs requiring infusion times as long as 6 hours, Dr Gadea’s group also assists drug manufacturers in developing tools to keep patients motivated and engaged in their care and to preserve their quality of life.
With drugs that are known to have a Risk Evaluation and Mitigation Strategy program, the management of potential adverse events can start at the first prescription, said Mr Hung, with alerts to local field nurse educators or other in-house nurses to reach out to providers or patients proactively.
Deployment of the right support programs, such as the provision of out-of-pocket payment assistance, by drug manufacturers can ultimately result in a decrease in therapy discontinuation, said Mr Hung. Optimizing the first use of a drug is important, and the support strategy will depend on the setting in which the patient is being managed (ie, community or academic).
“How do I support that optimal first experience so I know how this product is going to flow through the system?” Mr Hung asked. “The manufacturers have established teams that will allow that to happen, to set up the practice for success, and ultimately to set up the patient for success.”
Drug manufacturers have a great opportunity to add value by holding distribution partners more accountable through measuring prescription fill time, patient out-of-pocket expenses, and drug discontinuation rates, said Dr Gadea.
“We think that is very much a low-hanging fruit that a lot of manufacturers do not often take advantage of that could ultimately provide value across stakeholders,” he said.
