American College of Rheumatology 2011 Dinner
Innovations in Care Models
At a recent Reimbursement Intelligence program, we heard from managed care experts a clear message: Payers to Pharma: In Rheumatology, Innovations without Outcomes are Irrelevant.
Key Findings
Payers and Rheumatologists will face a variety of new market entrants including small molecules.
- Small molecule manufacturers should not consider their market entrants to be in a class of their own – they will be compared to all current biologic therapies.
- Head-to-head studies have arrived vs. Humira, the market leader, which can drive payers toward comparative effectiveness that may narrow this class.
Rheumatologists are also changing the way they conduct their practices.
- Significant number of practices are no longer infusing in their office and are sending their patients to alternative sites of care. This can drive selection to injectables that offer monthly dosages.
- New care models such as Accountable Care Organizations and Patient-Centered Medical Homecare, are driving site of care for infusion of RA products.
- Specialty pharmacy will play an increasing role in treating and managing patients on biologics.
Reimbursement Intelligence 2011 – 2012 Rheumatology Reimbursement Report and pipline products covers these key issues to gain feedback from 50 national payers and 100 rheumatologists.