When market access realities crimp a drug’s true value

A recent paper suggests that incorporating the real-world realities that keep drugs from patients should be included in a drug’s pricing assessment

While this recent article tackles the increased use of health equity as a factor for market access and acceptance for NICE, a recent paper from Health Affairs discusses the need for evaluating health system complexities when evaluating a drug’s value.

The article states: “Drug value assessments generally fail to account for the complexities of health care systems and thus can misinform price negotiations and lead to overly restrictive access policies.”

The authors cite many articles, some decades old, and suggest this a problem that has been discussed, but left behind. In fact, it reiterates the importance of the 2012 SIMULATE ISPOR Good Practices Task Force that recommended enhancing health technology assessments (HTAs) by using dynamic simulation modeling that would capture the factors that address the mismatch between medication value and marketplace realities. Those realities that aren’t captured in drug value assessments include the following:

• Heterogeneity of response
• Reimbursement challenges, which includes the ability to manage short-term budget impacts on more curative and expensive treatments.
• Policy constraints, here again as an example of Medicaid coverage being limited or denied for expensive cell and gene therapies.
• Geographic location, for example rare disease treatments that are available in relatively few places.
• System capacity and infrastructure gaps

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