Needed: New market access models in Ireland
In Ireland, an asthma management pilot suggests pharmaceutical companies need to start thinking more creatively about market access.
By on Nov 26, 2009In Ireland, an asthma management pilot suggests pharmaceutical companies need to start thinking more creatively about market access.
An asthma management pilot is evidence of a new realism that could rapidly transform the market access paradigm for pharmaceutical companies in Ireland. The question is whether industry is moving fast enough to absorb these changes. The demonstration project recently launched at some 25 primary care sites was developed by the Asthma Society of Ireland and is being implemented in partnership with the Department of Health and Children (DOHC) and the Health Service Executive (HSE). The plan is eventually to roll out the program nationwide in line with the governments Primary Care Strategy, which aims to shift chronic disease management out of hospitals and into the community.
Ireland has the fourth highest rate of asthma in the world and a poor record of controlling the disease. According to the Asthma Society, between 24,000 and 26,000 people each year end up in A&E due to an exacerbation of their condition, while severe exacerbations annually put 6,000 patients in hospital. Direct healthcare costs are somewhere in the region of 500 million a year.
The pilot scheme tackles these problems through a combination of evidence-based guidelines for asthma management, training programs for GPs, practice nurses and community pharmacists, and better links between general practice and hospitals treating asthma. Patients are encouraged to participate actively in managing their own condition through education on the correct use of inhalers, following a personal asthma plan and monitoring their asthma control with a peak flow meter.
Ireland took its cue from the National Asthma Program run in Finland between 1994 and 2004, which also emphasized co-ordination of guideline implementation, patient counselling and follow-up at primary care level. While the incidence of asthma in Finland continued to rise over that period, the number of hospital days attributable to the disease more than halved from 110,000 in 1993 to 51,000 in 2003, while annual costs per patient fell by 36% from 1,611 to 1,031.
For Pascal King, head of market access for Novartis Ireland, the more cohesive not to mention coercive approach to asthma management gives some indication of the way the wind is blowing, not just for the health service but for the pharmaceutical industry in Ireland. The countrys ambitious program of health reforms was hatched in a booming economy; now Ireland has plunged into recession. That means cost cutting. As King notes, the government has already put the squeeze on wholesaler and pharmacy margins. In the next budget, the DOHC is looking for savings of 800 million, and currently around 15% of healthcare expenditure is going on medicines. The rules of the game have changed, King comments. Next year could see reference pricing and prescription charges. But ultimately industry is going to have to bite the bullet. All thats going to do is bring the Irish market into line with the rest of Europe, King says.
With no real generics market in Ireland, some research-based companies are starting to talk about slashing the prices of off-patent drugs, if the savings can be ring-fenced for innovative products. And health technology assessment is on its way. Irelands Health Information and Quality Authority is gathering resources in this area and King foresees all innovative drugs being subject to some form of HTA from next year. He doesnt expect this process to be as forensic as in the UK. The Scottish Medicines Consortium is a more likely model, with a bit more pragmatism than the National Institute for Health and Clinical Excellence although King acknowledges that budgetary pressures could make Irish HTA experts more picky.
But the asthma management initiative is symptomatic of a broader trend, which is a real move to change the way drugs are administered, King says. What used to be a demand-led system, with too much wastage, is tilting towards one with a greater emphasis on compliance people wont have medicines unless theyre taking them right, according to King. In parallel, King believes, will come a more prescriptive approach to the range of medicines available. The HSE is assembling a core team of clinical directors who will determine which drugs are used for which condition and for what duration effectively a clinical diktat. King expects there to be 14 to 20 of these directors in the field of chronic disease.
The message for pharmaceutical companies in Ireland is that they need to take a serious look at their business models and to start thinking more creatively about market access. With the government looking to take a slice out of the drugs bill, industry is moving from conciliation to possible confrontation, King warns. At the moment, there is very little market access activity in Ireland. But we need to step up and be involved, King stresses. Companies should be considering issues like the costs of long-term care or the kind of risk-sharing schemes that have enabled national health service coverage of expensive new drugs in the UK or Italy.
Large teams of specialist hospital reps or traditional product managers are ill suited to this new paradigm, King suggests. Better to have some form of key account manager who can work to secure the right product price and clinical protocol. All the same, there will be an element of proceed with caution, King warns. For example, a successful asthma management program could have significant implications for drug costs. And Ireland already has some of the highest priced drugs for asthma and chronic obstructive pulmonary disease in Europe.