Allowing Payers Into Clinical Spaces Earlier Could Allow More Efficacy in New Technologies

Andrew Cournoyer, senior vice president and director of the access experience team at Precision AQ, spoke with The American Journal of Managed Care® about how introducing payers into clinical spaces earlier could have a positive effect on the introduction of new technologies.

This transcript has been lightly edited for clarity.

Transcript

Can more time for payers affect price negotiations when it comes to new technologies?

So I think with new technologies coming to market, I'm not sure necessarily it would extend the time to bring a product to market with the new technology by looping in the payer earlier. It actually may help set the stage or prime the market better if we can start getting better payer involvement. With the new technology, there's typically a lack of understanding, a lack in terms of either endpoints, lab values, or markers that are being used to measure efficacy, grading scale, standards of care, even guidelines. Especially with new technologies that are targeting rare disease, which may or may not be on a payer's radar, because they may only have 1 or 2 patients, or there's really nothing novel out there. So I think helping to get the payer involved earlier helps understand that. But then, even moreover, in terms of how it's going to ultimately define value for that product. And it could be price, it could be the efficacy and safety benefits it provides and how it moves the disease forward. And then ultimately how a payer forecasts what the downstream offsets look like if that drug becomes successful. So I think in areas where there's new technologies, there's probably a lot of education gaps. Getting them earlier, I think probably adds an efficiency vs slowing the process down.

How can introducing payers earlier affect Medicare negotiations?

I think having them evolve in the process earlier gives you that line of sight in terms of how payers view price to value and CMS in these negotiations has a starting point at the MFP level. And from there negotiation happens, and we want to support manufacturers and their ability to defend their price at the starting point and a lot of that comes down to evidence generation and the clinical development program. So if they've taken that payer lens, where CMS is the payer in this case, but they've done that earlier, hopefully the endpoints that they've generated through their clinical development or evidence generation helps defend their value in their price downstream in negotiations. So that's where I think the benefit back to the manufacturer is incorporating payer is that it can help them through those negotiations. To have, hopefully, a more robust evidence program in place.