A Case Study

We worked with a US-based biopharmaceutical company with a solid oral product in an established, competitive disease state to gain payer insights into drug pricing and optimize PRMA in multiple countries. 

Drawing upon our proprietary payer panels consisting of over 100 experts in the US and 30 experts in the EU, we aimed to evaluate payers’ understanding of the competitive market. Our panel included current and former payers and payer advisors to P&T/HTA bodies responsible for assessing new therapies’ clinical and economic value and negotiating prices at national and regional levels. We were interested in learning how payers would likely review, assess, and cover products based on their value, positioning, and economic benefits.

After conducting qualitative interviews with EU5 payers and payer advisors and US pharmacy and medical directors covering commercial, Medicare, and Medicaid, we were able to identify perceptions of essential unmet needs in the disease state and the value drivers within it. We reviewed and assessed product value probing on clinical merits and critical attributes within the product profile. We investigated unaided expectations of price range and analyzed how different price ranges may influence specific actions (or inactions), along with coverage and utilization management. We also discussed how to leverage different net price strategies to support target coverage and utilization management, including value-based, innovative approaches.

Our project findings led the client to consider a different price range than had been considered initially. Our clinical insights led to changes in initial payer messaging around product differentiation, and our competitive intelligence led to a more structured net pricing strategy.

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