As the U.S. considers implementation of the drug pricing provisions of the Inflation Reduction Act (IRA), which includes price negotiation for a limited subset of drugs, it is important to understand the nuances of a government price setting system rooted in comparative effectiveness research. Germany, for example, assesses relative clinical benefit of medicines as part of its price setting process. Compared to U.S. physicians’ value assessment, Germany’s assessments regularly value innovative medicines very differently than U.S. systems, illustrating some of the variability that is introduced when governments ultimately determine patient access versus providers.
To compare U.S. physicians’ perspective on value of pharmaceutical products to the perspective of Germany’s Federal Joint Committee (G-BA), we looked at products in three therapeutic areas: psoriatic arthritis, ulcerative colitis and multiple myeloma. Using a similar rating scale for all products, we surveyed U.S. physicians (Figure 1) and asked them to rate the benefits of medicines based on criteria used to define the “level of benefit.”
The results demonstrated a significant lack of alignment between how U.S. physicians rate the value of products in these categories compared with the G-BA. Across categories, for products that received a negative value determination from G-BA, the vast majority of U.S. physicians gave a more positive rating (Figure 2).
Value Elements of Ulcerative Colitis Products
When assessing the value of pharmaceutical products, U.S. physicians look to product characteristics that are often excluded from Germany’s assessments. For example, within ulcerative colitis, almost all the U.S. physicians agree that the products’ ability to address unmet medical needs is important in determining its value (Figure 3). Other important factors include extending life long enough for the next treatment to become available, the route and frequency of administration and indirect benefits of a medicine, such as the patient or their caregiver’s ability to work.
Value Elements of Psoriatic Arthritis and Multiple Myeloma Products
For psoriatic arthritis, most U.S. physicians agree that the products’ ability to address unmet medical needs is important in determining its value (Figure 4). Meanwhile, extending life long enough for the next treatment to become available is most important in determining the value of multiple myeloma therapy (Figure 5).
Conclusion
This study showcases the variability across value determinations between two countries – in this example the U.S. and Germany, and provides important perspectives about evolving regional systems and structures that ultimately inform patient access on a global scale. Understanding multiple value determinations can inform a more comprehensive access evaluation.
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Author
Jonathan Vu is a Senior Consultant of the Custom Insights practice at EVERSANA. Jonathan joined EVERSANA in 2019, bringing his expertise in global pricing and market access to the team. Jonathan has executed and…
Denise has more than 20 years of healthcare experience across sales, managed care, medical device, and hospital settings. In these leadership roles, she has hired, developed, and motivated over 500 representatives and district managers;…