Leaders in Pharmaceutical Business Intelligence (LPBI) Group

Trends in HealthCare Economics: Average Out-of-Pocket Costs, non-Generics and Value-Based Pricing, Amgen’s Repatha and AstraZeneca’s Access to Healthcare Policies

Reporter: Aviva Lev-Ari, PhD, RN

1.   AstraZeneca’s access to healthcare strategy is made up of three elements:

• Provide high-quality, effective and appropriate medicines to those who need them. Improve affordability, particularly among the growing middle class in Emerging Markets.
• Bring down healthcare barriers, particularly in developing countries. Our strategy helps us to address affordability and other healthcare barriers, while ensuring we continue to provide high-quality medicines to those who need them.
• Key Target exceeded Full target achieved Ongoing progress Target not achieved, some progress AstraZeneca has extensively expanded and updated their access strategy identifying those areas where they are best placed to provide support and are now well positioned for future progress.”
• “Access to Medicine Index Access to healthcare Goals Target progress Progress highlights Expand sustainable patient access to our medicines to reach 3 million patients by 2016 4.49 million patients in Emerging Markets served by patient access programmes
• Young Health Programme After exceeding initial goal to reach 1 million people through the Young Health Programme by 2015, aim to renew in five markets and expand into three markets by 2018 Renewed in Canada, Germany, China and India and expanded into Kenya
• Total reach in 2016 of 166,000 and 1.6 million youth since 2010
• Proposals for expansion are in development for Brazil and Australia and for renewal in Portugal
• Healthy Heart Africa Reach 10 million hypertensive patients across Sub-Saharan Africa by 2025 Since 2014, we have conducted over 2.7 million screenings and started treatment for over 100,000 hypertensive patients

SOURCE

https://www.astrazeneca.com/sustainability/access-to-healthcare.html

Click to access Access%20to%20healthcare.pdf

2.   Co-Development and Commercialization by Territory

AstraZeneca has paid $45 million and committed to up to $2.1 billion in milestones to team with Pieris Pharmaceuticals. The agreement sets Pieris up to move respiratory candidate PRS-060 into the clinic on AstraZeneca’s dime and pull in milestones as it and other pipeline prospects advance.

Tiny Pieris is due to receive the first, $12.5 million milestone when it moves moderate to severe asthma candidate PRS-060 into phase 1. AstraZeneca will fund clinical development of the interleukin-4 receptor alpha-targeting protein. If the asset reaches phase 2a, Pieris has the option to codevelop and commercialize it in the U.S., bumping up the royalties or gross margin share it receives in the process.

Pieris has a similar codevelopment option on other assets covered by the agreement. The biotech will develop four other proteins against undisclosed respiratory targets. If Pieris wants, it can sign up to codevelop and commercialize two of these programs in the U.S. Milestones and commercial payments across the deal could ultimately total $2.1 billion.

SOURCE

http://www.fiercebiotech.com/biotech/astrazeneca-pays-45m-commits-to-2b-to-team-pieris?utm_medium=nl&utm_source=internal&mrkid=993697&mkt_tok=eyJpIjoiT1RjMlpqWTFOakpsWVRVMyIsInQiOiI2dEgzSVFxWWZweDFiZ2JcL2EwbDk5MW1VcHJ6WnNNaGFmSEdLb2VnSTQ2QjRMUGpqcFFCQjM1dkVFT3dtNFMxaFZ4cXRhMTRQc0dxM28zVG5YM1FhM0hrQkhoS2ZDdWVickFGaWlOK2drRlwvdThzU1FcL05iY0FVSkNjXC9zMmNFSnkifQ%3D%3D

3.  Prescriptions Dispensed at Zero Patient Out-of-Pocket Cost Reached Thirty Percent in 2016

29.9% of prescriptions have been dispensed at zero patient out-of-pocket cost, including brands and generics, up 1.5% since 2015, all due to increased use of zero cost generics.
The total share of prescriptions where patients paid some amount less than $50 declined by 1.3% to 67.8% in 2016.
The proportion of claims with patient cost exposure greater than $50 increased also declined slightly from 2.5% to 2.3% in 2016.

Since 2013, Average Out-of-Pocket Costs for All Brand and Generic Prescriptions has Decreased by $1.19

Average patient out of pocket costs declined from $9.66 in 2013 to $8.47 in 2016, with 2016 brand costs declining to $28.31 from $32.36 in 2013 and generics dipping to $5.54 from a high of $6.05 in 2013.
The list prices of brands continue to be far higher than the average paid by patients, as few patients are exposed to those costs in their insurance plans.
The average list price for brands averaged 12 times higher than the average out of pocket cost for patients in 2016 compared to 3 times higher for generics.

SOURCE

http://www.imshealth.com/en/thought-leadership/quintilesims-institute/reports/medicines-use-and-spending-in-the-us-review-of-2016-outlook-to-2021#form
For Immediate Release Contact: Joan Fallon

May 2, 2017 joan_fallon@harvardpilgrim.org

617-509-7458

4.   Harvard Pilgrim Signs Second Groundbreaking Contract with Amgen For Repatha

HPHC and its members will receive full refund if a cardiac event occurs while on the drug

(WELLESLEY, MA) – Harvard Pilgrim Health Care has entered into a first-of-its-kind contract with Amgen for its LDL cholesterol lowering drug, Repatha, that guarantees the health plan and its members will receive a full refund of their costs for the drug if a member is hospitalized for a myocardial infarction or stroke after taking Repatha for six months or more and maintaining an appropriate level of compliance on the drug.

Repatha is one of a new class of biotechnology medicines known as PCSK9 inhibitors that have demonstrated a promising new approach for treating elevated LDL cholesterol in patients whose levels are not able to be controlled by current treatment options. The medication is designed to target a protein that prevents the body from removing artery-blocking LDL cholesterol from the bloodstream. Repatha works differently than statin drugs that prevent the liver from making cholesterol.

Given by injection every two or four weeks, Repatha is intended for patients who have an inherited disorder resulting in high levels of LDL cholesterol or have high-risk atherosclerotic cardiovascular disease conditions, such as heart attack or stroke, that have been resistant to treatment.

“Repatha has been shown to have a significant outcome on reducing cardiovascular morbidity for high risk individuals with elevated LDL cholesterol,” said Harvard Pilgrim Chief Medical Officer Michael Sherman. However, there have been concerns raised about the cost of this new drug relative to existing statin treatments. We hope to negotiate more contracts of this type, in which a pharmaceutical company truly has ‘skin in the game’ going forward. This agreement is the first we have signed in which there is a full refund of all costs related to the medication if the patient experiences a heart attack or stroke while taking it.”

“Cardiovascular disease is the largest public health concern in the world and for high-risk patients who have already had a cardiovascular event or whose genetics puts them at risk, it is important that these patients have access to an effective treatment shown to lower their

elevated LDL cholesterol in addition to their current lipid lowering regimen,” said Joshua J. Ofman, M.D., MSHS, senior vice president of Global Value, Access & Policy. “Amgen’s agreement with Harvard Pilgrim demonstrates our commitment to seeking innovative approaches that help break down the barriers of access to Repatha.”

This is the second patient-focused outcomes contract Harvard Pilgrim has negotiated with Amgen for Repatha. In the fall of 2015, the health plan signed an outcomes guarantee through which Amgen provided HPHC with an enhanced discount if the reduction in LDL levels for Harvard Pilgrim members is less than what was observed during Repatha’s clinical trials. In addition, the agreement provides for additional discounts if the utilization of the drug exceeds certain levels. This enables those patients who can most benefit from the drug to receive it while continuing to encourage utilization of lower cost statins for the majority of patients.

SOURCE

From: “Fallon, Joan” <joan_fallon@harvardpilgrim.org>

Date: Tuesday, May 2, 2017 at 1:09 PM

Subject: press release from Harvard Pilgrim Health Care