Report 4: PLA Perspectives, Comparison and Contrast
Last week Manulife introduced its new DrugWatch™. It has been described by Manulife as the only program of its kind in Canada which “closely monitors the drug landscape and analyzes the effectiveness and financial impact of new medications, to ensure you receive value for your drug benefit dollars.” This initiative is rather unprecedented as it marks the first time a major private payer in Canada is placing significant emphasis on the Canadian Agency for Drugs and Technologies in Health’s (CADTH) recommendations for products. It also places emphasis on “expert negotiation” to seek the best possible drug prices for their clients. This could mark a sea-change in the private payer landscape depending upon how other major carriers respond to this initiative.
These recent developments coincide well with the release of the fourth and final report from PDCI Market Access (PDCI) and H3 Consulting’s (H3) Private Payer Product Listing Agreement (PLA) Series. This series provides the results of an online survey of a select group of Canadian private payers and manufacturers. The purpose of this survey, which was conducted between June 29, 2015 and July 17, 2015, was to enhance the understanding of the prevalence, objectives, and content of private payer PLAs in Canada.
This concluding report in the PLA series compares and contrasts findings from the first three reports and includes our outlook for the next few years based on respondent comments and our own market knowledge. Some highlights of the report include:
- We expect more agreements in the next 2-3 years with a continuing focus on price and cost reductions rather than clinical or market outcomes. Private payer PLAs are likely to focus on specialty products.
- It is not clear if private market PLAs benefit drug manufacturers, other than on a very selective basis. In the absence of tangible or immediate threats to access, payers have a greater interest in initiating discussions than manufacturers.
- PLAs are likely to focus on price reductions rather than outcome measures. Payers may be willing to adopt the same clinical outcomes as provincial PLAs, or may want to explore other outcomes based on productivity, improved health status, shortened periods of absence, and/or disability plan use. This survey revealed that some outcome-based agreements have been completed.
Please click here for a complimentary copy of the fourth report entitled, “Report 4: PLA Perspectives, Comparison and Contrast.” Through the month of September, we issued the following four reports:
- Report 1: Negotiation-Naïve & No Interest in Negotiating a Private Payer PLA
- Report 2: Negotiation-Naïve & Interested in Negotiating a Private Payer PLA
- Report 3: Experience Negotiating Private Payer PLAs
- Report 4: PLA Perspectives, Comparison and Contrast (NEW)
If you have any questions regarding the report, please contact Courtney Abunassar, PDCI’s Manager of Market Access and Policy Research.