This week we launched Evidex Alerts, a new feature that provides our clients with real-time updates on the latest impactful drug safety news. This is a project that our development and analyst teams have worked on diligently for the last three months, and I am excited to announce that it became a reality this week.
As 2016 winds down, am I the only one who feels exhausted?
Between pharma-bro inspired drug pricing madness, a political season that felt like a Bravo reality TV show, and Leicester City robbing my beloved Tottenham Hotspur of their first shot at a Premiere League championship in a very long time, I think John Oliver summed up this year best in this video.
Healthcare systems are generally slow to adopt new technologies. For all the talk about leveraging “Big Data,” the industry has been even slower to adopt analytics to make those data actionable. In fact, not one state Medicaid agency currently uses an evidence aggregation platform with post-approval adverse drug events intelligence when creating preferred drug lists, writing prior authorization criteria, negotiating supplemental rebates, educating prescribers and dispensers, or performing prospective, concurrent, or retrospective drug utilization reviews. This is in spite of the fact that millions of patient lives are put at risk and billions of dollars are spent every year from adverse drug events. Yet there is no mandate to use readily available, reliable data to inform making decisions about prescription medicines.
Fortunately there are the outliers - innovators and early adopters that see things differently. They know that they can make a difference by incorporating new ideas and approaches to improve patient outcomes and their own bottom lines.
Product liability insurers protect pharmaceutical companies from legal actions associated with their drugs. They have a significant economic incentive to scientifically assess and understand the scope of litigation risk. Experienced underwriters use an evidence aggregation platform to better understand if a manufacturer’s drug is causing severe side effects that could lead to potential litigation. They also use an evidence aggregation platform to adopt and employ a simplified and unified process of assessing side effect risk with proven statistical measures via a simple interface that deploys in minutes.
Managed Care Organizations are reviewing drugs well before a product is approved. According to a survey conducted by Dymaxium (the company behind the AMCP eDossier System) and presented in a recent webinar, two out of three healthcare decision makers begin to evaluate a drug at least six months prior to approval. The survey also indicates that the primary source of information that payers are using for these pre-approval evaluations is clinicaltrials.gov (CT.gov), and that manufacturers are not always responsive to requests for information pre-approval.
Drug safety is often equated with post-marketing pharmacovigilance, something that is required by manufacturers only after their drug is approved. But when drug safety data are presented in an evidence aggregation platform there are very strong use cases in pharmaceutical competitive intelligence, health economics and outcomes (HEOR), and R&D. An evidence aggregation platform takes multiple sources of information and boils it down into actionable insight. That insight often has use cases that span all departments and can meet the demands of various priorities.
Clinical data transparency has been under fire for years. There are documented cases of negative clinical trial results not being reported, leading to organizations like AllTrials.net. Trial end-points are often a moving target, being changed mid-trial, leading to organizations like Compare-Trials.org. And it’s not only manufacturer sponsored research either. As STAT pointed out, most research institutions routinely fail to meet reporting requirements as well.
Furthermore, negative data and important safety issues are often “hidden” in publications, outside of the requirements of reporting laws and standard practices. The lack of full transparency leads to evidence based medicine without all of the evidence, and makes pharma CI's job of fully understanding competitors’ data especially difficult.
One form of hidden data points are adverse events that are not listed as “serious” in clinical trials because they do not lead to death, hospitalization, or life-threatening situations.
Health Economics and Outcomes Research (HEOR) teams are using evidence aggregation platforms to conduct observational and retrospective studies using both clinical trial results and real world data. Whether a single database is being used for analysis or a combination of multiple datasets are combined, the best evidence aggregation platforms will incorporate standardized analytics that allow for efficient and effective insight generation. One of the key resources a HEOR team needs is the ability to standardize the downstream medical costs of drug adverse events.
In August 2016, CVS Healthcare announced its 2017 formulary exclusion list. The formulary exclusion list is a list of drugs that pharmacy benefits managers (PBM) like CVS Healthcare have decided to stop paying for in favor of a different, preferred drug. While preferred drugs may be chosen for safety or efficacy reasons, oftentimes economics plays a strong role.
One of those exclusions sent shockwaves throughout the pharmaceutical drug industry—the exclusion of Lantus (insulin glargine recombinant) in favor of its biosimilar Basaglar. That exclusion by CVS is expected to significantly impact Lantus’ sales. EvaluatePharma shows revenue for Lantus dropping from $7 billion in 2015 to $2.9 billion in 2022.
To prepare for more exclusions and continued pressure by payers that favor biosimilars, pharma CI, Medical teams, HEOR, and other commercial and R&D teams within drug manufacturers need to be prepared to fully understand any potential differences the biosimilar may show compared to the reference product. The data will be used for competitive insight as well as evidence generation to position the reference product as a safer choice, as soon as any potential differences are seen.
Constructing accurate drug and competitive market forecasts is a vital function of pharmaceutical commercial teams. A model that combines patient-based and event-based assumptions provides for a stronger understanding of the drug’s market, and accounts for potential scenarios that could affect what patient populations are treated. A lot of data need to be synthesized to create the best forecast possible. Evidence aggregation platforms are well suited to this task.
Let’s examine the case of a new drug entering a market which is claiming superior safety and efficacy vs. standard of care. While it is expected to quickly take market share, there are concerns that the advantages may only be seen in certain patient demographics. If true this would significantly alter patient-based forecasts and market penetration models.