The Aequitas Group
Reimbursement Landscape Analysis - Rare Bleeding Disorders (Hemophilia)
A global healthcare company was preparing to launch several blood disorder products within 10 years. In order to increase the client’s understanding and awareness of the future reimbursement environment, The Aequitas Group conducted a global health technology assessment incorporating private payor research, Medicaid and state funded program analyses.
From a US and a Global perspective, The Aequitas Group determined based on the Blue Cross Blue Shield (BCBS) Technology Evaluation Center (TEC) Criteria whether the client’s pipeline products were as beneficial as any established alternatives and if any improvements were attainable outside the investigational settings. These individual criterions were encompassed in other global regulatory authorities such as the National Institute for Clinical Evidence (NICE). This task required an analysis of the expected clinical outcomes for each product and the development of a pharmacoeconomic model that utilized presumed prices for the launch of the products, which was very important in assessing global launch implications.
While hemophilia products had traditionally been sheltered from utilization restrictions, recent and anticipated future changes in the reimbursement landscape suggested that hemophilia may not remain a protected class by the time our client launched their products. Through our research, we determined both the probability of states implementing a preferred drug list category for factor products as well as the impact of spending caps on special drug classes such as hemophilia.
In order to adequately capture information on the European reimbursement dynamics for hemophilia products, in relation to existing and future alternative therapies available in Europe, The Aequitas Group organized market research interviews with clinical and policy experts to address key considerations for the European union. A blinded product survey that included an overview of the hemophilia market and different treatment options was presented to the stakeholders to inform their evaluation. The insights obtained from this group assisted in understanding potential payor perceptions of current and future trends. In addition, we were able to use these opportunities to explore policy concepts and preferences for each of these decision-makers, to gauge the current level of understanding and market awareness.
Based on the research results, we developed short and long-term strategic considerations and recommendations for the client to utilize in addressing reimbursement obstacles or issues from multiple perspectives, including the provider, payor, and patient.
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