Time to Access: Too fast, too slow, or just right? Presented by George Wyatt, Executive Senior Consultant Data Analysis by Dr. Eric Siu, Senior Manager March 29, 2017
GETTING TO ACCESS: Time to Access: Too fast, too slow, or just right?
Apr 12, 2017
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Time to Access: Too fast, too slow, or just right?
Presented by George Wyatt, Executive Senior Consultant Data Analysis by Dr. Eric Siu, Senior Manager March 29, 2017
InnomarConsulting™
§ Innomar Strategies acquired Wyatt Health (Dec.‘16)
- Formed InnomarCounsulting™
§ Plus Innomar Strategies offers:
- Regulatory Support
- 3rd Party Logistics
- Pharmacy Services and Networks
- HealthForward Payer Services
- Nursing and Clinics
- Patient Support Programs, and more
Full Canadian Reimbursement Services
Full Service Solutions
3/29/17 CONFIDENTIAL 2
The Parties and Responsibilities
Time Frame Who’s Responsible 1. Regulatory Period (prior to NOC) Pharmaceutical Company 2. Reimbursement Evaluation HTA Body (CDR, pCODR, INESSS)
Private Payers 3. “Price/Value” negotiations pCPA & Pharmaceutical Company 4. Reimbursement Decision Public and Private Payers
3/29/17 CONFIDENTIAL 3
Median Days: NOC to CDR Submission
3/29/17 CONFIDENTIAL 4
11
37 32
55
31
91
64 52
61 55 41
27
5
-61
36 43
8
126
202 222
72
97
52 42
116
83
37
70
-100
-50
0
50
100
150
200
250
Day
s (M
edia
n)
All DRD
Median Days: CDR Submission to CDR Recommendation
3/29/17 CONFIDENTIAL 5
181 187 180
212 202 194 193 202181
202
301
232
189201195 189
167182
210
160
202 203 197
262
362
215 207
0
50
100
150
200
250
300
350
400
Days(M
edian)
All DRD
CDR not afraid to change
§ 24th edition of Submission Guidelines
- Changes every year, except 2012 – when CDEC codes changes
§ 17th edition of CDR Procedures
§ 120 CDR Updates
§ Nearly 500 submissions
§ Over 400 recommendations
- Positive type recommendations increasing
3/29/17 CONFIDENTIAL 6
3/29/17 CONFIDENTIAL 7
Median Days: CDR Recommendation to Active pCPA
3/29/17 CONFIDENTIAL 8
7975
0
10
20
30
40
50
60
70
80
90
All DRD
Days(M
edian)
Median Days: Active pCPA to pCPA Completion
3/29/17 CONFIDENTIAL 9
152
184
0
20
40
60
80
100
120
140
160
180
200
All DRD
Days(M
edian)
pCPATotal=259days
pCPA Total = 231 days
Median Days: CDR Recommendation to Reimbursement
3/29/17 CONFIDENTIAL 10
293
219
307341 319 320
219
355
290 290
-47
280
466
719
429 443
351
456
386
0
455 438
-104
422
-200
-100
0
100
200
300
400
500
600
700
800
AB BC MB NB NL NS ON PEI SK AVG(w/oQC)
QC AVG
Days(M
edian)
All DRD
Poster at 2010 CADTH
Symposium
3/29/17 CONFIDENTIAL 11
Median Days: CDR Recommendation to Reimbursement
3/29/17 CONFIDENTIAL 12
2004-2009 – Extracted from Poster Presented at CADTH Symposium – April 2010
What’s happening & What does it mean for patients
§ Time from Recommendation to Reimbursement is Increasing - Too slow for many patients
- <200 days (2004-2009) to 280-290 days (2004-2017) = 9+ months
- Drugs for Rare Diseases is now 422-438 days = 14+ months
§ pCPA process has added Time - Responsibility: pCPA and Pharmaceutical Companies
> Strong preparation is very important
§ More Warning Clouds - pCPA (drug plans) may not negotiate when drug receives HTA Recommendation with
Clinical Criteria and/or Conditions
> Perceived no unmet medical need
> Payers may not have resources
§ Every delay can hurt a deserving patient - We can’t relax – we need to be persistent with our message
3/29/17 CONFIDENTIAL 13
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