Payer Views on Pricing and Reimbursement in Oncology

This report provides an in-depth analysis of the evolving landscape of oncology drug coverage and pricing, focusing on the perspectives of payers in the US and EU. It explores the key considerations influencing payer decisions, the impact of recent changes within payer organisations and the dynamics of their relationships with the biopharmaceutical industry. Readers will gain insights into the strategies payers employ to manage costs, including the use of innovative payment methods and the challenges posed by rising drug prices. The report also examines the role of biosimilars, the influence of clinical guidelines and the potential effects of industry consolidation and policy changes on payer decision making. This comprehensive analysis is informed by interviews with experts who have extensive experience in oncology pricing and reimbursement.

Key Questions Answered:

• 1. What are the key considerations for payers when making coverage and pricing decisions for oncology drugs?
• 2. How have recent changes influenced payer thinking about oncology drug coverage and pricing?
• 3. What factors most heavily impact changes in payer decision making for oncology drugs?
• 4. How can payers and the biopharmaceutical industry collaborate to improve decision-making processes?
• 5. What issues and trends could influence future payer decision making in oncology?
• 6. How do payers' approaches to oncology drug coverage differ between the US and EU?

Key Companies:

Partial List of Participating Experts:

• Associate Director, Office of Health Economics, UK
• Senior clinical account executive at a leading pharmacy benefit manager, US
• President and CEO, Cooperative Benefits Group
• Specialty pharmacy co-founder and oncology leader at payers in the US
• Senior Healthcare Consultant at ADVI Health and former National Medical Director, Aetna, US
• Independent consultant and experienced managed care executive, based in the US
• Senior Vice President, Specialty, Real Endpoints, US
• Venture Partner at RA Capital Management and former EVP and CMO for Harvard Pilgrim Health Care and Point32Health, a regional not-for-profit health plan in the US

Methodology

Dossier reports are developed from independent and concise analysis derived from original industry surveys and in-depth interviews with industry thought leaders. Reports analyse in detail significant developments and market trends that pharma executives need to understand if they are to manage the opportunities and challenges that lie ahead. The focus of each report is defined by a review of the secondary literature and any knowledge gaps identified. Based on this initial research, an evidence-based and expert-informed discussion guide is developed to ensure the research answers the most critical questions. Additionally, robust screening criteria are established to ensure that those interviewed are qualified in terms of their experience, knowledge and stature to speak on the topic.

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