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HMR 3rd Qtr14: Workshop Report - Biosimilars: Changing the pharmaceutical landscape and the way

HMR Africa
Mediscor Client Workshop 2014.


Compiled by HMR journalist.

Biosimilars are poised to change the way speciality medicines are funded and accessed in future. That was the key message from this year`s Mediscor Client Workshop on 14 August. It was the 12th time the company, which recently celebrated its 25th anniversary, had hosted the event.

Christo Rademan

Madelein Bester, Manager: Benefit Management, presented the most important findings from the Mediscor Medicines Review for 2013, looking at trends in healthcare expenditure and cost drivers in the private healthcare sector. The data were drawn from 20 medical schemes and the approximately one million lives covered by these schemes. Overall, between 2012 and 2013, there was a 1.9 percent increase in total expenditure, the first such increase noted since 2011. This was mainly attributed to rising item costs (2 percent), and was offset by a minor decline in utilisation (0.1 percent).

Dr Justine Greeff

New chemical entities (NCEs), defined as products launched within the previous five years, accounted for only a small proportion of claims: 1.7 percent of expenditure and 0.3 percent of volume. NCEs are generally more expensive than existing medicines, averaging R747 per item versus R138.

Where generic utilisation was concerned, representing the other side of the coin, 75 percent of all items claimed were either generics or originator products with available generics. Non-genericised originator products therefore accounted for only 25 percent of items claimed. The respective item costs were R241 (originators), R131 (originators with generics) and R96 (generics).

Madelein Bester

The biggest increase in generic use was seen in oncology, with utilisation increasing from 50.2 percent to 56.7 percent. Where provider type was concerned, most claims came from retail pharmacies, which accounted for 82.7 percent of volume and 79.5 percent of expenditure, representing a slight increase over 2012.

The top three therapeutic groups represented in the claims database were antihypertensive, cytostatic and antidiabetic treatments. The top three products were Lantus® Solostar®, Celebrex® and Nexiam®. Speciality medicines (including biologics, but excluding oncology treatments) showed a 5.9 percent increase in cost per beneficiary per annum, and accounted for 3.1 percent of total medicine expenditure. Because they come at a premium price, they represent a key cost driver. ``On the positive side, however, generic usage continues to increase and makes a huge difference,`` Bester concluded.

Jurie Wessels

Stavros Nicolaou, Senior Executive: Aspen Pharmacare, addressing the impact of benchmarking, noted that the decline in the value of the rand had an automatic benchmarking effect. He observed that, since the introduction of the single exit price (SEP), there had been a reversal in medicine expenditure trends. Based on data from the Council of Medical Schemes Annual Report, it was currently at an all-time low of 16.9 percent in the private sector, and therefore could not be considered a cost driver. ``The SEP has, therefore, worked. But, because there will always be `outlier products`, there is a need for benchmarking.``

Sunette Volschenk

Benchmarking focuses on two particular categories: newer state-of-the-art technologies like biologics, and older patented products with no or very limited competition. A new methodology for benchmarking released in May 2014 aims to address some of the unintended consequences of earlier exercises. Members of the pharmaceutical industry have submitted their comments and they do have some issues with the proposed benchmarking process, not least the provision that it would not be a once-off exercise. ``That would have made more sense, given that SEP adjustment will in any event take future currency movement into account,`` said Nicolaou. ``It also fails to address patient access principles. If it is to enhance their access to treatment, an uptake in volumes is required in addition to price cuts.``

Stavros Nicolau

An exciting new development at Mediscor is the recent launch of the Mediscor Information Centre (MIC). It is a secure, centralised depository that allows access to all claims data, financial values, preauthorisation information and authorisation letters, as well as a Mediscor formulary search facility and a generic alternative search function. ``The MIC allows for real-time access via the Internet or intranet, and can be customised for call centre purposes, supporting our clients` own call centre agents,`` said Jurie Wessels, Manager: Business Integration. The MIC will be rolled out comprehensively in 2015.

Dr Skhumbuzo Ngozwana

Three talks and a panel discussion facilitated by Dr Justine Greeff, spotlighted the subject of how biological medicines, and biosimilars in particular, are changing the pharmaceutical landscape. ``Biotechnology products already account for almost 70 percent of the top 10 best-selling drugs and will dominate in the years ahead,`` said Dr Skhumbuzo Ngozwana, MD: Metanoia Pharma Counselling. ``Biosimilars offer significant projected savings over biological originator products; €11.8 billion in the EU and $250 billion in the USA. Funders in South Africa need to be prepared for their use here, too, and those who don`t yet have a biosimilar strategy in place need to develop one urgently, ensuring a pragmatic pathway for allowing patient access to these treatments.``

Dr Henry Leng

As yet, no biosimilars have been granted registration in South Africa, as the dossiers submitted to the Medicines Control Council (MCC) have not met the organisation`s regulatory requirements, notably with regard to safety data, according to Dr Henry Leng, a member of the MCC. All biosimilar applications require a comparative report vis a vis the originator, and it`s at this level that products submitted to the MCC have failed the rigorous data requirements. However, he is encouraged that biosimilars will, in due course, allow greater access to therapies that either cure or at least improve quality of life for people whose clinical needs remain unmet by small-molecule therapies, and at a 20-30 percent price reduction relative to originator products.

Heidre Ferreira, head of the Oncology, Transplant and Biosimilar Business Unit of Sandoz SA, shared the company`s international experience as the world leader in biosimilars, underscoring that Sandoz is well placed to spearhead developments in South Africa. ``We are the number one biosimilar company globally with a comprehensive pipeline, and the considerable savings our products have brought about in Europe can be duplicated here,`` she said.

Mediscor`s Sunette Volschenk, Manager: Managed Care, and Henk de Jager, Manager: Plan Design, gave an overview of the company`s benefit design initiatives. ``We focus on acting in the best interests of the patient, while minimising the risk to schemes,`` said Volschenk, ``and we are well placed to help our clients manage speciality medicines like biosimilars.`` Mediscor believes that effective benefit design leads to cost-effective medicine choices, and is looking at ways to ease patients` co-payment burden.

For more inforation contact Mediscor PBM:

Tel: +27 12 674 8000

Posted on Monday, September 29 @ 13:39:46 SAST by E-Doc
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