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Innovative Agreements for Financing Medicines:
a new way of involving stakeholders
in paying for real health outcomes
WS 5: Establishing multi-stakeholder pain platforms in Europe
Jaime Espín, PhD
Professor
Copenhagen, 30th May 2012
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Disclosure Statement of Financial Interest
I, Jaime Espin DO NOT have a
financial interest/arrangement or
affiliation with one or more
organizations that could be perceived
as a real or apparent conflict of
interest in the context of the subject
of this presentation.
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Agenda
• Pharmaceutical Policies – Some
general aspects to remember
• New way of financing medicines
• The role of different stakeholders
in this new way of financing
medicines
• Some Conclusions (and
proposals)
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DIFFERENT STAKEHOLDERS - INTERESTS
Pharmaceutical Sector In Europe
GOVERMENTS
Control expenditure
Accessibility
PHARMA INDUSTRY
Patents
Profits
EUROPEAN UNION
Free movement of goods
Competitiveness
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Difficult balance for
Goverments
Industry policy goals
Public Health
Control Expenditure
Innovation
Competitiveness
Access to affordable medicines
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Difficult balance for
Goverments
Public Health
Control Expenditure
Access to affordable medicines
Industry policy goals
Innovation
Competitiveness
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New way of financing medicines
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Why these new Agreements?
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Low Level of Innovation
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Source: Priority Medicines for Europe and the World. WHO. November 2004
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NO CURE, NO PAY
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New Trend
Pharmaceutical
Policies based on
price regulation
Macro
New Pharmaceutical
Policies based on rational
use of resources and cost
effectiveness
Micro
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Velcade Risk-Sharing Scheme
Individual NHS Trusts
Janssen-Cilag
Patient initiated on Velcade
Provision of stock for first 4 cycles
for each patient at cost to NH
Respond withim 4 cycles
Fail to respond within 4 cycles
Continue on Velcade at cost
to NHS
Discontinue Velcade
Trust claims for replacement
stock or credit
Fuente: PPR Sept 07
Replacement stock or credit at
cost to Janssen-Cilag
Audit if “unusual” rebate pattern
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MEDICINE
INDICATION
A
NICE Technology
Appraisal
Payment of a fixed sum for a
patient commencing on a
regimen irrespective of
actual costs incurred
Gefitinib
(IressaR)
1st line locally advanced or metastatic non
small lung cancer
NICE Approved drug
B
Sunitinib
(SutentR)
1st line advanced/metastatic RCC
NICE Approved drug
Reimbursement of initial
phase of treatment
C
Reimbursement of
treatments after an agreed
period
D
Reimbursement for
treatments that do not
result in anticipated benefits
Sunitinib
(SutentR)
Unresectable or metastatic GIST
NICE Approved drug
Sorafenib
(NexavarR)
1st and 2nd line
advanced RCC
NICE Rejected drug
Sunitinib
(SutentR)
2nd line advanced RCC
NICE Rejected drug
Cetuximab
(ErbituxR)
Lenalidomide
(RevlimidR)
Ranibizumab
(LucentisR)
Trabectedin
(YondelisR)
Lapatinib
(TyverbR)
Bortezomib
(VelcadeR)
Cetuximab
(ErbituxR)
Sorafenib
(NexavarR)
Metastatic colorectal cancer
NICE Approved drug
Relapsed myeloma
NICE Approved drug
Wet age related macular degeneration
NICE Approved drug
Treatment of advanced soft tissue
sarcoma
NICE Approved drug
Metastatic breast cancer
NICE Rejected drug
Relapsed myeloma
NICE Approved drug
Metastatic colorectal cancer pretreated
Hepatocellular carcinoma (advanced and
st
metastatic) –1 line
NICE Rejected drug
NICE Approved drug
E
Discount applied to the total
monthly cost
F
Erlotinib
(TarcevaR)
Non small cell lung cancer
NICE Approved drug
Azacitidine
(VidazaR)
myelodysplastic syndrome, chronic
myelomonocytic leukaemia and acute
myeloid leukaemia
NICE Rejected drug
Bevacizumab
(AvastinR)
Other
B+E
1stline treatment of metastatic colorectal
cancer –negative ACD
Not reviewed by NICE
1st line treatment of metastatic breast
cancer in combination with taxane
chemotherapy
Not reviewed by NICE
Degarelix
(FirmagonR)
advanced hormone dependent prostate
cancer
NICE Approved drug
Everolimus
(AfinitorR)
2nd line treatment of advanced and/or
metastatic RCC– negative ACD
Not reviewed by NICE
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Incentives under traditional and risk sharing contracts (I)
Source: “Risk-Sharing pricing models in the distribution of pharmaceutical”. Staff
Working Paper 2003.1. Andrew Lilico. Febrery 2003
Under traditional
contracts, the firm’s
revenue does not
depend on the
realisation of the
success rate. Once
the medicine is
accepted on the
positive list, the
company is
guarantue revenue of
π* per-unit sold,
independently of the
actual
performance/outcome
of the drug
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Incentives under traditional and risk sharing contracts (II)
Under risk sharing
scheme, if the succes
rate is zero, the firm
does not receive any
money. But if the
actual succes rate is
far above expections,
the per-unit profit π
exceeds the π* level
Source: “Risk-Sharing pricing models in the distribution of pharmaceutical”. Staff
Working Paper 2003.1. Andrew Lilico. Febrery 2003
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Incentives under traditional and risk sharing contracts (III)
An intermediate
solution (dotte line)
is the the risk sharing
scheme where the
firm is guarantee
some small fee
per unit sold and a
“bonus” per every
successful treatment.
Source: “Risk-Sharing pricing models in the distribution of pharmaceutical”. Staff
Working Paper 2003.1. Andrew Lilico. Febrery 2003
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Why about implementing these
new agreements for pain
medicines?
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Thank you for your attention
Jaime Espin
[email protected]
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