Filed Under:Health Insurance, Individual Health

PwC Survey: Drug Manufacturers Must Demonstrate Clinical, Economic Benefits of Products

Photo credit: vichie81
Photo credit: vichie81

A shift in consumer and provider preferences could hurt revenues for drug manufacturers that don’t speed efforts to demonstrate the clinical and economic benefits of their products, according to a new PricewaterhouseCoopers survey.

PwC, London, U.K., published this finding in a survey that explores how well health insurers and pharmaceutical companies work together using information about drug effectiveness in the care of patients. The phone survey of executives at 100 different health insurers uncovered the following:

• To be considered for drug formulary placement, 82% of health plans say a drug manufacturer must demonstrate a clear clinical benefit compared with current branded and generic treatments, and 78% demand clear proof of cost savings.

• 75% of insurers characterize their relationship with pharmaceutical companies as transactional vs. collaborative. • 44% said they aren’t at all confident in the data provided by the drug industry • 16% of health insurers have adopted new payment and contracting arrangements such as outcomes-based payments, risk-sharing agreements and bundled payments with pharmaceutical companies. Of those that haven’t, 37% expect to adopt them within the next three years.

• Only five percent of health insurers are very confident—and 44 percent aren’t at all confident—in the economic data provided by the drug industry when making coverage and formulary decisions.  Only seven percent are very confident in the information to evaluate a drug’s comparative effectiveness.   • More than half (52%) of insurers rely on independent data to evaluate drug effectiveness.  The three most influential factors health plans use when making formulary decisions are:  the availability of a generic equivalent, physicians’ opinions and regulatory guidance. • Sixteen percent of health insurers have adopted new payment and contracting arrangements such as outcomes-based payments, risk-sharing agreements and bundled payments with pharmaceutical companies.  Of those that haven’t, 37 percent expect to adopt them within the next three years. View the full report here.

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