Prescription drug affordability is a major concern in health and life science—and not just in the U.S. Mounting drug costs have put huge strains on global health systems and have contributed to a crisis in access to medicines for millions of people.
In our latest expert Q&A, we talk to independent market access specialist Asif Velani and Will Wright, now the VP of Digital and Innovation at Protective Life Insurance. This spring, Will and Asif co-led an engagement with one of Business Talent Group’s global life science clients aimed at tackling affordability.
During the project—which was structured as a series of full day workshops—Asif, Will, and three other independent health and life science experts helped our client create a framework for evaluating affordability models and, ultimately, aligning around a single pilot.
Market Access Innovations: Prescription Drug Affordability Models
What was the goal of this project?
Asif: We were working for the client’s global market access and value group, which was hoping to assess the feasibility of different financing approaches. Before we came in, the group had engaged a large strategy consultancy to examine how other industries had addressed similar challenges. They had also done some work internally around affordability. We were engaged to galvanize internal resources and help them use that work to identify one or two pilots to take to phase two.
Why did you propose a workshop?
Asif: Everybody has ideas. Our intent was to drive towards something tangible, something they could actually put into play.
Will: One of the things that’s great about well-designed workshops is what’s possible in terms of speed-to-pilot. When large companies need to move quickly, it requires a certain freedom of thought and willingness to invest time. The ideation process enabled us to articulate various pieces of what I would call an operating model for the pilot, forcing fast decisions and moving towards something real.
How were these workshops structured?
Asif: For each workshop, we created standardized templates for the client to complete. During the first workshop which was focused on brainstorming potential models, we came up with eight or nine potential models. Next came a feasibility assessment to narrow down to four or five worth future development. Between each workshop, we coordinated with executive stakeholders and conducted additional research. Pretty quickly, it emerged that amortized payments represented the most viable option. So during the final workshop, we built guidelines for when and where it was appropriate: when are you eligible for putting a drug into a scheme like this, who are the populations, and so on.
Can you tell me a little bit about those guidelines? What’s the rationale for amortization in pharma payments?
Will: The rationale for amortization is to align your pricing to the value you deliver, especially with high-cost therapeutics that are curative. Patients recoup the benefits of your therapy over multiple years, as does society yet its paid for upfront. From the pharma side, amortization allows you to maintain pricing that reflects those benefits. From a societal perspective, it allows you to spread the costs out over the lifetime of the value you’ve received.
Asif: Strategically, it can also be a source of competitive differentiation instead of traditional discounts.
What are some of the challenges when it comes to implementing amortization programs? Initially, many payers were resistant to the idea.
Will: I think the question is not whether amortization will work but how. In my experience, building new payment capabilities such as amortized payments can be difficult. The claims and payment systems that currently exist aren’t built to handle this kind of financing. This is, of course, fixable, but getting there will require investment and creativity.
What are some of the challenges with affordability in general?
Asif: I think it can be a struggle to remember what you’re solving for. Typically, you’re trying to address several challenges at the same time, because affordability affects multiple stakeholders. It protects the patients, but it also affects the payer. In some cases, it affects the health authority. Physicians will engage with you differently based on how you implement the solution.
Will, you come at this issue from a patient advocacy perspective. How does that figure into all this?
Will: Patients are increasingly exposed to the cost of being sick, and a lot of them lack the resources to absorb these costs. We all know that, but how much are we willing to embrace it? It’s important to think beyond the development of life-saving therapeutics to the endpoint, which is the patient value we’re delivering. So creative financing is important not just from a bottom-line, revenue perspective—increasing utilization and access by enabling people to pay in different ways—it’s also valuable from an end-user patient perspective.
What was the most interesting thing about this project?
Asif: I enjoyed seeing the genuine interest within the client’s team to actually solve the affordability challenge. They aren’t just doing this because it’s politically correct, but because they genuinely want to ensure that patients get access to their drugs. The hard part for them was saying, “Okay, we have to make some trade-offs. We can’t analyze everything.” And they were very surprised that in an 8-week effort, they were able to narrow down to one or two pilots and actually align people around it.
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