With health insurers looking for ways to save money, more and more of them are focusing on drug outcomes, using those data to drive coverage decisions. But getting that information may be easier said than done.
In the more than seven years I’ve been writing Specialty Pharmacy News, there has always been discussion about communication gaps among the various pharma stakeholders. But the one that seems the most baffling is that between insurers and pharma manufacturers. For years I’ve heard that drug companies have plenty of data on their products … but they’re not data that health plans really want, mainly because they aren’t robust enough to allow for comparative clinical and cost effectiveness. And even though it seems like it would be in pharma companies’ best interests to provide those data — assuming that they have confidence in their products, of course — according to a new study from PwC, that isn’t happening very often.
Almost half of the respondents — who were executives at 100 health insurers — said they are not confident in data that the drug industry provides. And three-quarters said that their relationships with pharma companies are strictly transactional rather than collaborative. Only 16% of respondents said they had established new contracting arrangements with manufacturers such as outcomes-based contracts, risk-sharing arrangements and bundled payments.
So what are health plans really looking for, and why aren’t manufacturers providing it? Is this information that manufacturers can provide, or do plans have unrealistic expectations?