Pricing and Contracting Strategies Factor into Payer Determination of "Best Products" in Specialty

The value of a specialty therapy lies not only in its clinical safety and efficacy, but also in how its price compares with other therapies in its class, found a new report.

Most of the recent big-name company reports have noted that specialty spend is one of the biggest cost-drivers in overall drug spend, and it is predicted to increase by nearly 70% by 2015. As such, it should come as no surprise that price has a major influence on a health plan’s choice of whether to cover a given specialty therapy.

A recent survey of 57 pharmacy and medical directors conducted by the Health Industries Research Companies (HIRC) reported that payers choose their specialty “product of choice” based primarily on price. Although clinical safety and efficacy is of great concern, and formulary preference is an important factor as well, the respondents said that the price of available therapies trumps all other considerations when it comes to choosing specialty products.

The researchers concluded that the top product in the multiple sclerosis space was Copaxone (glatiramer acetate injection), which beat out Rebif (interferon beta-1a), Avonex (interferon beta-1a), and Betaseron (interferon beta-1b) “due to its large market share, clinical safety and efficacy, and long-term data.” Respondents reported that another factor affecting Copaxone’s designation as the “top product” was that it is scheduled to lose patent protection in the next few years.

The health plan representatives in the survey also rated manufacturers based on the quality of the resources and account support associated with each medication. Their responses indicate that Novartis and Sanofi lead in account support, whereas Biogen Idec has the best programs associated with their drugs.

The full survey included 28 specialty medications across 10 key therapeutic areas.