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What is Value in Healthcare: The payer definition

What is Value in Healthcare: The payer definition

  • September 2016
  • ID: 4201032
  • Format: PDF
  • Firstword Pharma


Table of Contents

How Pharma can meet payer’s expectations of value
Payers want value, but what does that mean? Is it price, efficacy, safety, clinical outcomes, the patient view or wider health savings? With no consensus on the definition of value, how can industry meet the expectations of diverse and often sceptical US and European payers to secure market access?
Informed by expert payer and industry opinion, What is Value in Healthcare? The payers’ definition identifies the critical elements of value for payers, reviews ways value is assessed and proposes practical strategies for how companies positively engage to build their value case.
“Often there is a conceit amongst the pharmaceutical industry that if their product is really innovative, we will pay a lot more for it. We won’t. We want improved outcomes.”
Commissioning Pharmacist, UK

Leading Pharma and Payer Experts Answer Key Questions:

Cause and effect: What’s driving the “value” revolution and how might it evolve?
Start at the beginning: How can early payer engagement help industry build payer-specific value propositions
Building the evidence: How can the inclusion of real world evidence can be harnessed to support clinical data in building a persuasive value case for payers?
Assessment frameworks: How should Pharma respond to the emerging value assessment frameworks that are influencing US payers’ decision making?
Smart pricing: Where do risk sharing, pricing by value or pricing by indication schemes fit into the value debate? More radically, will long term drug “mortgages” offer an alternative funding model?
Value added: Why are some payers not seeing the value in Pharma’s beyond-the-pill value-added services programmes?

Key Topics Explored

While all payers want value, each will have their own assessment methods and expectations of what that means.
Trust and goodwill is not overabundant in the payer/Pharma relationship, but positive engagement is critical if both parties are to work efficiently.
The need to prove on-going value in the long term is vital to support and defend pricing and formulary position
Could Multi-Criteria Decision Analysis (MCDA) offer a more holistic approach to determining the value of a product that has wide stakeholder support?
Companion diagnostics can be potential game changers in establishing value.

16 knowledgeable experts share their thoughts
This powerful report harnesses a wide-range of experience from the US and EU5 countries. To ensure candid views were expressed the names of contributors have been kept anonymous.


A healthcare professional working at the Italian Medicines Agency (AIFA)
A Commissioning Pharmacist working at NHS England
A former member of the Transparency Committee within the Haute Autorité de Santé (HAS) in France
An expert working at the Basque Office for HTA in Spain
A Medical Officer working at the National Association of Statutory Health Insurance Funds in Germany
Executive Vice President at a large Pharmacy Benefit Management organisation in the US
A Medical Director of a US integrated health services organisation
A Pharmacy Director at a large health plan in the US
A Technical Adviser working in the Catalan Health Service in Spain

Pharmaceutical industry

A Head of Global Health Technology Assessment and Scientific Strategy working in a research-based pharmaceutical company in the top 10 by global sales
A Market Access Director working in a research-based pharmaceutical company in the top 10 by global sales
A Value Evidence Lead working in a research-based pharmaceutical company in the top 10 by global sales
A Health Economics and Outcomes Research Manager working in a research-based pharmaceutical company in the top 50 by global sales
An Associate Director of Pricing and Market Access working in a research-based pharmaceutical company in the top 50 by global sales

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