Meet the Expert

3 Barriers Faced by Patients Needing Innovative Technologies — and How Pharma Can Help: MMIT Meet the Expert Webinar Recap on Access Trends for Innovative Technology

May 5, 2021

On April 27, MMIT held the next installment of its ongoing Meet the Expert webinar series. This session was focused on trends surrounding patient access to innovative technologies like cell and gene therapies, genetic testing and telemedicine. All three of these technologies have seen huge advances in development and availability — and patient access to them is rapidly changing as well, said MMIT’s Fiza Bari, a senior manager of custom market research.

She described a patient named Rose, who has a Diffuse Large B-Cell Lymphoma. Rose is eligible for chimeric antigen receptor (CAR) T-cell gene therapy that will take her own DNA and create a personal treatment that will target her cancer cells. Her family may also wish to pursue genetic testing, while Rose has been taking advantage of telemedicine this past year due to the pandemic. What access challenges does she face?

On April 27, MMIT held the next installment of its ongoing Meet the Expert webinar series. This session was focused on trends surrounding patient access to innovative technologies like cell and gene therapies, genetic testing and telemedicine. All three of these technologies have seen huge advances in development and availability — and patient access to them is rapidly changing as well, said MMIT’s Fiza Bari, a senior manager of custom market research.

She described a patient named Rose, who has a Diffuse Large B-Cell Lymphoma. Rose is eligible for chimeric antigen receptor (CAR) T-cell gene therapy that will take her own DNA and create a personal treatment that will target her cancer cells. Her family may also wish to pursue genetic testing, while Rose has been taking advantage of telemedicine this past year due to the pandemic. What access challenges does she face?

(1) Cell and gene therapies: Cost is a major barrier to accessing these innovative agents, according to MMIT’s quarterly surveys of payers, providers and practice managers, which capture key insights about major trends impacting access. CAR-T therapy is “high cost,” said one large national carrier with 11.9 million lives. It’s less expensive for the “employer and carrier to continue with maintenance drugs given the lack of stability in employment/carrier.” A regional plan cited “accountability for providers, hospitals, and pharma.” It added, “What if the drug doesn’t work?” Those challenges have led payers to establish complex prior authorization requirements, which in turn impacts oncology practices — and leads to a high administrative burden.

Pharma companies can help by negotiating outcomes-based contracts to help mitigate some of the risk for payers, ultimately making the therapies more easily accessible for patients. These companies also can help ease the administrative burden faced by oncologists and practice managers by providing more support and information on the therapies.

(2) Genetic testing: Rose’s family may want to access genetic testing since B-cell lymphoma can be hereditary. However, many payers require prior authorization for these genetic tests because of a lack of perceived utility. One national plan with 3.9 million lives lamented the “lack of documentation [and] off-label use,” while a pharmacy benefit manager (PBM) with 11.1 million lives said the “standard of care [is] not well established and testing centers [are] not easily accessible, expensive.”

How can pharma companies help ease these barriers? MMIT’s research showed that for payers that cover over 90% of lives, positive outcomes data and inclusion of the need for the genetic test in the therapy label are the most influential factors in deciding to cover testing. So by providing payers with information around labelling and outcomes, pharma can help reduce the administrative burden for oncologists and thus improve access for patients.

(3) Telemedicine has become much more widespread as a means of reducing the risk of COVID-19. According to MMIT’s research, all payers reimburse for telemedicine, and most payers will cover these services for all disease states, not just for COVID-19. But while this access likely will continue for conditions such as behavioral health and dermatology in the post-COVID era, payers see less value in providing access to telemedicine related to oncology services. This can impact patients like Rose, who have seen the benefits of fewer physician visits with telemedicine. Manufacturers can help by providing physicians and payers with educational materials and support in order to encourage the use of telemedicine.

For more information about how MMIT’s market research can help you understand payer and provider perceptions, contact us today at busdev@mmitnetwork.com.

To watch a replay of this webinar, visit www.mmitnetwork.com/meet-the-expert-innovative-technology-webinar.

And check out our webinar lineup here. The next session on May 18 is about Predicting Enrollment Changes in the COVID Era.

5 Things to Consider When Launching a New Drug: MMIT Meet the Expert webinar recap on Predicting Payer Uptake with Precision

April 14, 2021

On April 6th, MMIT kicked off a six-part Meet the Experts webinar series. The first session was focused on predicting payer uptake with precision. For example, many pharma manufacturers use analogs to predict payer uptake of a new drug being launched into the market. Tracking how an analog drug performed can help drug manufacturers improve messaging to payers, identify coverage challenges, and accurately predict payer uptake.

But choosing the right analogs can be challenging, said MMIT’s Carolyn Zele and Ritupriya Yamujala. Suppose the manufacturer’s drug is the first oral oncolytic for a particular tumor type. What criteria should the manufacturer consider in selecting an analog for comparison:

On April 6th, MMIT kicked off a six-part Meet the Expert webinar series. The first session was focused on predicting payer uptake with precision. For example, many pharma manufacturers use analogs to predict payer uptake of a new drug being launched into the market. Tracking how an analog drug performed can help drug manufacturers improve messaging to payers, identify coverage challenges, and accurately predict payer uptake.

But choosing the right analogs can be challenging, said MMIT’s Carolyn Zele and Ritupriya Yamujala. Suppose the manufacturer’s drug is the first oral oncolytic for a particular tumor type. What criteria should the manufacturer consider in selecting an analog for comparison:

(1) Launch order. Where does the new drug fit into the market? Were there other drugs recently launched or will it be among the first? How many drugs have already been discussed by the payer’s Pharmacy & Therapeutics Committee in this class? For example, if the new therapy is the first launch in that category in a long time, the manufacturer should choose an analog that was also launched into a stable market.

(2) Clinical data. For a novel drug that had breakthrough therapy designation, it can be hard to find a drug with significantly similar clinical data. But you can look for an analog drug that is also novel and breakthrough and thus posed similar coverage considerations for a payer’s Pharmacy & Therapeutics Committee meeting.

(3) Pricing. How does the price of the new drug compare to the prices of the drugs already available? Is it going up against any rebate contracting? The manufacturer should select analogs that launched with a similar price differential or similar contracting availability.

(4) Physician preference or bias. Since this drug is the first oral in the market for a particular tumor type, the manufacturer may encounter physicians who are skeptical that an oral will work as well as the infused products and should find an analog that faced similar challenges.

(5) Market Share. What is the patient population taking today and is it working? Is the payer currently getting a rebate and what are the terms? Does the current rebate require preference? Is it based on clinical outcomes? If the payer decided to cover this drug, what would it mean for any current rebate agreements?

For more information about how MMIT can help you with launch predictability, contact us today at busdev@mmitnetwork.com.

To watch a replay of this webinar, visit www.mmitnetwork.com/meet-the-expert-predicting-payer-uptake.

And check out our webinar lineup here. The next session is on April 27th and the topic is Access Trends for Innovative Technology: Cell and Gene Therapies, Biomarkers and TeleMedicine.