The current global recession has accelerated the
implementation of rules that dictate how new medical
products are reimbursed. Certain products already on
the market are being withdrawn when benefits are not
considered significant. Many European health
agencies have established rules concerning the type of data
they require to evaluate the value of new medical
treatments. In the United States, both physicians and
patients have taken actions to counter the rapidly rising
costs of new drugs and medical services. Although the
rules differ in each country and are evolving, it is certain
that the pharma industry, as well as providers of medical
services, will need to provide evidence of the value of
their products in order to establish their level of
reimbursement.
Factors
Considered in Establishing Value
The
Situation in Europe
-
Real world data is
required
-
Comparison with current standard
of care
-
no reimbursement for inferior products
-
no or reduced reimbursement for identical
products
-
higher prices for superior products
-
National healthcare budgets are
shrinking or flat
-
Rules vary from
country-to-country
Factors Considered in Establishing Value
The Changing Situation in USA
-
Real world data is
desirable
-
There are no national standards
or requirements
-
Physicians at Memorial
Sloan-Kettering Cancer Center in New York refused to use
a new colon cancer drug because it was twice as
expensive an another drug without being better
- More than 100 oncologists protested the high cost
of cancer drugs in an editorial in the journal Blood
-
Patients in USA become medical tourists to
reduce costs
- A new
hip costs $78,000 in USA and
$13,660 in
Belgium