SOURCE: Reimbursement Intelligence

Reimbursement Intelligence

November 30, 2011 11:06 ET

Payers to Pharma: In Rheumatology, Innovations Without Outcomes Are Irrelevant

MADISON, NJ--(Marketwire - Nov 30, 2011) - Reimbursement Intelligence, a New Jersey-based market-research firm, today announced at the 2011 American College of Rheumatology dinner presentation experts delivered a tough message from payer care: innovations without better outcomes are irrelevant.

Senior executives from major pharmaceuticals companies heard stern messages from Maria Lopes MD, Chief Medical Officer, AMC Health; Jeff Berkowitz, Senior Vice President, Pharmaceutical Development and Market Access at Walgreens; and Rhonda Greenapple, Chief Executive Officer, Reimbursement Intelligence.

New oral therapies, such as JAK and SYK inhibitors, are not able to shake the grip on the market held by the leading large-molecule therapies. Plans will need to compare new market entrants to current biologics and "decide what is the added value based on efficacy and safety, without clinical differences defined by the product's value and driven by cost," noted Greenapple.

Physicians, too, will be reluctant to use the new oral therapies until they have "real world experience" with them. Nor will physicians be as easily swayed by traditional marketing efforts.

Lopes stated, "The most expensive drug is the one you don't take, physicians hand over a prescription and think patients are taking it appropriately -- paying for high cost drugs that are not being administered means we are not receiving the full value we are paying for."

A significant share of Rheumatology practices no longer infuse in their offices and are sending patients to alternative care sites. The practices are "less likely to utilize IV therapies when Humira, Embrel and Cimzia are readily available for self-injection," added Greenapple.

Berkowitz explained how specialty pharmacy can implement effective Rheumatology management programs that offer case management, training and clinical data to show improved compliance and outcomes.

"We provide at our sites injection training which doctors say they just do not have the time to spend with patients," stated Berkowitz.

In developing their Rheumatology management program, Walgreens gathered data that showed 50% of patients were not getting their appropriate induction dose.

"This is inexcusable to payers, pharmaceutical companies and providers," added Berkowitz.

For additional information about the ACR dinner and for all presentation materials, please click here: ACR Dinner or visit

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Since 2005, Reimbursement Intelligence ( has helped biopharma and medical device clients overcome the single most important challenge to successfully commercializing medical innovation: the reimbursement environment.

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