Expanding in a Restricting World: Value Added Medicine
In every jurisdiction across the globe, spending in healthcare is under fire and medical interventions whether biopharmaceuticals or medical devices, appear at the epicenter. Many countries/provinces have been asked to limit any increase on their budget or find savings overall. Funding of medical interventions has been shifting in recent years to more of a commodity approach for many areas with it being difficult to demonstrate value behind incremental innovation. An additional challenge is the opposing force between policy makers and innovative researchers – both of whom have the ultimate goal of improved health and outcomes for patients.
Over the last 15-20 years, the healthcare space has undergone tremendous growth and expansion through innovation and research. However, yesterday’s innovation is today’s commodity. HIV/AIDS in the 80’s was a breakthrough disease that had policy makers shifting their spend not only to innovative research and treatment but also to a change in infrastructure to accommodate the acute treatment of a disease that is now treated as a chronic condition mostly with medications off patent. Other more common illnesses have seen incremental innovation to address population health issues such as depression, type II diabetes, Crohn’s disease to name a few. Through this incremental innovation, disease states once treated at a high cost due to the limited treatment options and interventions, have become ones with multiple therapeutic choices with significant price decreases due to market saturation and loss of patent exclusivity.
Fast forward to today where treatments are becoming highly specialized and the opportunity for incremental innovation correspondingly more complex and targeted. In doing so, we have numerous examples of breakthrough medications that benefit a smaller number of patients but in a significant way. One only need to look to the recent treatments for Hepatitis C that have revolutionized the impact of this disease in an area where treatment leading to a cure was of low probability and arguably toxic. Recent treatments are creating a challenge for policy makers as treating patients curatively has a greater short term cost, with potential long term outcome benefits for patients. At the same time, health system cost savings are long term and often beyond the life span of most government cycles. A similar dilemma faces innovative researchers who spend the better part of their professional lives innovating and failing in the hopes of finding a cure for various types of chronic and episodic diseases, looking for that breakthrough that truly impact patients’ lives and provides innovators with the resources to continue innovating.
The influence and role of payers and government has increased steadily for over a decade. More and more, government policies influence most aspects within the value proposition for researchers from price to volume to health economic evaluation. This impact is borderless as developed countries reference each other for data, pricing and value whether it’s another drug in an existing class with incremental benefits or a breakthrough medication for leukemia. Finding opportunities for growth at times might seem daunting at times.
Expanding in a Restrictive Environment
All players in this situation need to ensure a balance in focus on the impact on individual patients as well as the broader health system in order to expand their business vs. getting solely focused on the data, numbers and price. It really is a shift to defining value and ensuring that true value, small or large is researched, positioned and portrayed while building a business case that takes into consideration all of these factors. Challenging this opportunity is the constant shifting of market access policies at a much faster rate than research can adjust to. Opportunities to grow in these markets involves a number of factors including ongoing engagement with leaders in these fields and playing a role as partner to ensure the value needed is the value provided.