Oncology, Pricing and Cappuccinos: A Report From the Oncology Market Access 2011 Conference in Rome

06 Oct 2011 Gustav Ando

We're blogging live from the IHS-sponsored Oncology Market Access 2011 Conference in the "Eternal City" of Rome, where the focus has been the age-old issue of optimising price and reimbursement for high-value cancer drugs. As the conference speakers have repeatedly mentioned, this issue is all the more pertinent in today's world of government austerity measures and payer belt-tightening - but at the same time highly innovative cancer therapies are reaching the market and demanding very high prices.

The conference has gathered 50-odd experts from the pricing and reimbursement and health economics field, mainly executives from the pharmaceutical industry, but also payer representatives and generics companies. From the outset the hottest topic has been risk-sharing agreements - an area in which Italy has been an unsuspecting pioneer in developing systems and standards. And it is interesting to note that on the conference floor there seems to be a tangible shift in perception on this subject from pharmaceutical companies.

Gradual Acceptance of Risk-Sharing
I've spoken about risk-sharing agreements at length at many conferences over the past five years, and my scepticism of their actual value has usually been shared by the vast majority of the audience. Whilst it is clear that there is still significant industry uncertainty over the benefits of such arrangements, it's equally clear that resigned acceptance of their necessity in many markets is slowly giving way to something resembling a positive attitude. The experience among the leading companies whose products have been subject to risk-shares, at least in Italy, seems to be: "not too bad".

Still, one attendee innocently asked, "What are risk-sharing agreements?", and I believe he unwittingly stumbled upon the key conceptual issue around this topic: everybody has their own opinion about what they mean, and there is very little agreement or indeed guidence on how to best to integrate this issue into sophisticated market access strategies.

European-level Harmonisation of Cost-effectiveness Guidelines
Interestingly, despite ongoing fears that the wider economic crisis is killing the European single market project, there is significant talk among the pharma executives over the potential for European-level harmonisation of cost-effectiveness guidelines as a means of replacing the complex and constantly evolving national-level standards and regulations. Whether such an institution - the kind of "EuroNICE" that we have spoken of in the past - would be a good or a bad thing for the pharmaceutical industry is still open to debate: and the truth of course is that there is a mixture of both.

In theory, there should not be much to prevent European alignment on the comparative effectiveness of a new product, based on its underlying science and not linked to the local environment of each country. This could lead to one cost-effective price that would subsequently guide national implementation. This could potentially side-step ongoing issues surrounding international reference pricing in Europe which currently skews the market because of its reliance on list prices.

Italy's Single Market Access Advantage
Since we are in Rome, it is only fitting to also speak of the major (only?) advantage of the Italian market over almost all others when it comes to pharmaceutical market access: its patient registry. Italy's five-year-old patient registry, which has enabled the risk-sharing system that is in place, is envied among the conference delegates for the amount of extra information that it can provide on the cancer patient's journey with the disease and treatment. It is something which most would like to see in all markets, given that it benefits pretty much everyone.


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