Payer Management Of High-Cost Brand-On-Brand Combination Therapies In Oncology

OBJECTIVES: In recent years, brand-on-brand combinations of high-cost therapies have become a reality in the oncology space, particularly in areas such as multiple myeloma. The synergistic value of combining drugs with complementary mechanisms of action is expected to considerably bolster the benefit to the patient; however, the cost of using branded combinations increases exponentially due to the longer treatment duration, therefore making the regimen unaffordable. This research aims to explore pricing and market access issues that health systems have encountered during the evaluation of such therapies and potential solutions to make these regimens more affordable. METHODS: In-depth reviews of published sources were conducted, including a thorough analogue assessment. Primary research interviews with fifteen payers in the EU5 markets were conducted to support analysis and conclusions; payers were selected based on their involvement in the pricing and market access processes in their respective country and to reflect the different layers of decision-making (national, regional and/or local). RESULTS: The majority of drugs included within brand-on-brand combinations are already perceived as expensive in monotherapy, therefore, willingness to pay for a combined regimen is low. Payers are increasingly looking to innovative pricing models beyond simple discounts and in agreement with different manufacturers of the various therapies including within combination regimens in order manage budget impact. However, the complexity of the agreements and potentially unfair reflection of the value-based price for individual drugs is problematic. CONCLUSIONS: Aligning the differing priorities of patients, payers and manufacturers is critical for finding mutually beneficial solutions. The operating models of both payers and manufacturers will require innovation in order to meet these increasing needs.