More and more drug companies can't assume that any drug they put forth will automatically be reimbursed by insurance companies at whatever price tag the drug company slaps on the product.
A Reuters story, whose link is here, reported on a recent example and is based in part on a PricewaterhouseCoopers survey of U.S. health insurers. PwC's survey indicated that four-fifths of insurers polled now require evidence of cost savings or a clear clinical benefit to include new products on their lists of covered drugs.
"In cases where there are co-pays, they really do effect the consumer," said Mark Mynhier, partner, healthcare industries advisory at PricewaterhouseCoopers, according to Reuters. "Patients are saying 'I can't afford to pay 10 or 20 percent of a $100,000 therapy.' "
The story noted that doctors at New York's Memorial Sloan-Kettering Cancer Center opted for a lesser-priced cancer drug. Reuters said they decided in November not to use Zaltrap, a new $11,000 a month colon cancer drug, because it has a "modest" impact on survival, works no better than Avastin, a similar but cheaper competitor, and has worse side effects. The hospital said Sanofi aventis, which makes the drug, offered a discount on the wholesale price, but that was not enough to make the hospital's list of available drugs.
"In order to warrant the price, you are going to have to have better overall survival," said Rhonda Greenapple, chief executive at Reimbursement Intelligence, a consulting firm specializing in medical reimbursement, according to Reuters.