Analytical Engine

Interesting things are taking place in pharmaceutical industry, which I believe has the potential to change pricing landscape of high cost drugs.

In June’07, the National Institute for Health and Clinical Excellence (NICE) of UK decided that Johnson and Johnson’s multiple myeloma drug, the one year treatment of which stands at around USD 48,000 a year, can be defrayed for if the company is willing to refund the cost in case of not showing a pre-decided level of cure.

This move towards sharing the risk of treatment outcome did not go unnoticed. Providers are all the more willing to share the risk of no-outcome with the drugs manufacturers. Biogen Idec, maker of Avonex for Multiple sclerosis drug that costs around $18,000 a year has made a dynamic pricing agreement with UK’s NICE. Under the plan, 5.000 multiple sclerosis patients are being followed for 10 years to see the effect of the drugs in slowing the progression of the disease. The prices of the drugs will be adjusted based on improvement of performance. Merck-Serono has offered to refund the primary care cost if its drug Erbitux if the patient does not respond within 6 weeks.

Although Europe seems to be leader in this development, but US companies are definitely taking note. United Healthcare have made an agreement with Genomic Health with United paying for the $3,460 genetic test to determine whether a woman with early-stage breast cancer would benefit from chemotherapy. If tests don’t have the intended impact of lowering chemotherapy United Healthcare will negotiate a lower price for the tests.

Essentially this development adds a new dimension to the pharmaceutical pricing, i.e, risk. Before pricing a drug, the point of paramount interest to both manufacturer and providers is what drugs are the ideal candidates for outcome-based pricing? The high cost drugs which are new in the market or have relatively low success rate seem to be the ideal target from the developments so far. The principal risk that companies should take into account is financial risk, which in turn will depend upon probability of no- outcome and amount of dollar exposure. Apart from regular variables such as physician’s ability, patient’s specific variables etc. there may be exogenous factors such as pollutions level for certain treatment which will affect the probability of outcome.

There are several interesting questions already. Will the companies have different refund policies for different locations? Will there be selection criteria? How will regulatory environment affect the risk-sharing?

We are at an interesting corner here. I will wait and watch how the pricing territory shapes up in the near future.