Defining access potential - before it’s too late

Guest commentary: Companies need to define access potential before it’s too late

We see it everywhere: confirmation bias.

Innovators believe in a drug, find the evidence to support its value, and dismiss or ignore the facts challenging their preferred story.

But confirmation bias is particularly problematic thanks to reimbursement -- a market-maker still unfamiliar to the majority of drug developers. Its arcane rules, logical inconsistencies (“Saving money in two years -- fine. Saving a lot more, but over five years -- not fine,”) and Rube Goldberg structure of influencers make it far easier for execs to assume reimbursement success will follow clinical value, defined in the relatively narrow way traditional in the biopharmaceutical industry, and leave it at that.

It’s a dangerous assumption.

Industry and its investors need a clear, objective lens through which they can burn away confirmation bias and see the likely access barriers their drugs will face once approved.

Had such a lens been applied to 2017 launches like Regeneron Pharmaceuticals Inc.’s Dupixent dupilumab or Radius Health Inc.’s Tymlos abaloparatide-sc, investors wouldn’t have been as surprised at their commercial challenges. Nor would they have been surprised on the upside by the breakout success of AbbVie Inc.’s Mavyret glecaprevir/pibrentasvir.

The questions for investors and companies are: Which drugs will payers want, and be able, to restrict? Which ones will get a pass? And once that’s figured out, what do the manufacturers do to maximize the commercial potential of these products?

As an example of how to systematically apply an access lens, we designed an algorithm called Access Meter that incorporates the roughly two dozen elements that would either block or allow patients access to a

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