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Do Payers Really Want Pay-for-Performance?

Product Code:
Publication Date:
September 2018

Explore the latest payer views and requirements for pay for performance

When it comes to payment for performance (P4P), it's notoriously difficult to know exactly what payers want to see. Useful face-to-face payer discussions about P4P requirements are few and far between—but you don't want to develop a complex proposal, only to discover that no one is interested. This report solves the problem by revealing what multiple senior level payers and former payers in the US and Europe are now saying about P4P—and what they are most concerned about.

In Q3 2018, we conducted in-depth interviews with 7 current or former payers in the US and Europe. They told us exactly what they want to see from P4P contracts.

  • Where to focus: Not every drug or disease area is suited to P4P. Where do payers believe attention should be focused and why? What areas should pharma avoid?
  • Getting payers on side: Introducing P4P adds complexity for everyone. What will persuade payers to make the change and shift away from traditional discounts?
  • Sharing the burden: What is fair and reasonable regarding risk sharing? How can cost issues be resolved and ensure both sides view the contract as fair?
  • Defining outcomes: What do payers believe is convincing and measurable? How should data be collected and reported—and by whom? What legal constraints must all parties be aware of?
  • Valuable guidance: From outcomes to evidence, from suitability to contract length: this report is packed with new strategies to consider and the pitfalls to avoid.

What to expect from this report

This is the most current and detailed information available today about what a range of payers and former payers in both the US and Europe think about value-based contracts. You'll find out exactly what they think, including how interested they really are in P4P, what they look for, and how they believe P4P should evolve over the coming months.

Use Do Payers Really Want Pay for Performance? to ensure your P4P approach is targeted, useful and stands the best chance of gaining support from payers.

How did we do it?

  • We identified 19 current issues regarding payment for performance
  • We explored these via an average of 22 targeted questions put to each payer/former payer
  • Their responses provided 69 unique new insights
  • Insights are supported by 150 directly quoted comments and 46 cited sources

Example insight included in Do Payers Really Want Pay for Performance?

"Some payers don't believe that there is really a shifting of risk from payers to companies. Pharma companies will typically have more information on their own product than payers, so there can be distrust amongst payers that the P4P offer is really a good deal. Drug manufacturers will need to consider offering greater transparency in order to overcome such understandable scepticism."

Example quote included in Do Payers Really Want Pay for Performance?

"P4P might be better in a niche product area and not in larger disease areas with a lot of treatments already. With ultra-orphan drugs for example, the number of treatment centres are limited and monitoring required for the agreement is more likely to be done. A big patient population is potentially overwhelming."

The expert panel for Do Payers Really Want Pay for Performance?

  • Chief Clinical Officer, US health plan
  • Pricing and reimbursement expert and former committee member of a regional pricing and reimbursement committee dealing with high cost medicines in a region of Spain
  • Former Chief Executive Officer, US health plan
  • Former Staff, National Institute for Health and Clinical Excellence (NICE), UK
  • Former Senior Post at the National Association of Statutory Health Insurance Funds (GKV-SV), Germany
  • Former Scientific Advisor, Italian Medicines Agency (AIFA), Italy
  • Member of Staff at a pharmacy benefit management company (PBM) in the US

Why buy now?

A significant change in mindset is difficult to achieve, risky and needs time and resource to do properly—and moving away from the familiarity of 'price per pill' is no different. To successfully secure valued-based contracts, first you need to get into the payer mindset and understand what they need—but that's easier said than done. This report gives you the up-to-date inside knowledge needed to craft a stronger P4P strategy. Because if you don't update your payer perspective, you risk wasting time, effort and ultimately failing to secure market access with P4P. And that benefits no-one.

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