Pricing, Reimbursement and Market Access

Based on consultative into provincial and national economic evaluation guideline development, years of experience as preferential reviewers of both national and provincial drug program submissions and based on our own successful submissions to national and provincial formularies, PATH is intimately aware of what formularies want in submissions and what decision makers need. From this PATH has developed a set of highly successful strategies for helping companies to determine optimal pricing for their product, for preparing valid and trustworthy submission dossiers and for maximizing market access and penetration.

In terms of pricing, PATH has developed a framework whereby pivotal trial data is combined with rapid literature review information in a preliminary economic model to assess the likelihood of successful reimbursement status at different pricing strategies before a final price is set for the product.

With respect to reimbursement, PATH has extensive experience in reviewing drug submissions and based on our ‘inside’ knowledge of what formulary committees are looking for, and what decision makers need, ensures that submissions have the highest success rate possible. Knowing where submissions fail and which analytical assumptions are obstacles are key for developing a successful submission strategy. Our submission dossiers are transparent and presented in understandable language in order to minimize the need for re-submissions.

Finally, PATH can help prepare Value Propositions and Key Messages for decision makers in order to maximize market access. These customized strategies and messages depend on the disease, technology competitive landscape and company needs, but may include analyses of the literature or of administrative databases in order highlight trends in the incidence, prevalence, mortality or general burden of disease. Similarly cost-of -illness studies can be conducted to highlight the relative importance of treating the underlying disease, or surveys and administrative databases can be used to highlight patient need, gaps in patient management, utilization patterns or to position the technology’s place in an overall treatment algorithm for patients. PATH Information Specialists and statisticians can prepare a detailed summary of the scientific evidence of the safety, efficacy, comparative effectiveness and cost-effectiveness evidence at the national and international level to supplement the product’s clinical and economic dossier.