#ClinicSpeak & #PoliticalSpeak: indication-based pricing is one-way to get ocrelizumab to PPMSers

Before we short-changed PPMSers can we think for creative solutions to the pricing of ocrelizumab? # ClinicSpeak #PoliticalSpeak

I am rather disappointed with the survey response I have had in relation to the results of the ocrelizumab PPMS study and whether or not the results are clinically meaningful. I am deeply concerned that pwPPMS in the UK will not have access to ocrelizumab because it will be priced to treat relapsing-forms of MS and this will make it too expensive to pass cost-effectiveness thresholds for PPMS. In PPMS the cost will be compared to best supportive care and it is highly likely that NICE will say ocrelizumab is too expensive. This means those who can afford to pay for ocrelizumab privately will do say. Life sucks if you poor you won't be able to access ocrelizumab. 

I have argued many times for differential pricing of ocrelizumab, i.e. a lower price for treating PPMS will make it cost-effective. Is the NHS and Roche ready for differential pricing? There is an interesting perspective piece in this week's NEJM covering indication-based pricing, which is another term for differential pricing. It is a very good read and makes a strong argument for differential pricing. 

If you have not done so already can you please complete the survey below? I plan to publish it online and send it the EMA and NICE at the appropriate time.

Thank you.

Effects of Uniform Pricing versus Indication-Based Pricing. In scenario 1, the value of the treatment is relatively retained across indications; in scenario 2, the value is low for indication C, which affects a relatively large population.

Chandra & Garthwaite. The Economics of Indication-Based Drug Pricing. N Engl J Med 2017; 377:103-106.


...... Pharmaceutical treatments and medical devices often have varying effectiveness depending on the indication for which they’re used: in oncology, for instance, response to a treatment varies with the type of tumor and stage of disease. The advent and proliferation of precision medicine in which biomarkers — whether genomic, proteomic, or structural — identify patients likely to receive greater treatment benefits only increase the range of variability in the effectiveness of the same product.

...... Yet manufacturers traditionally charge the same price for all indications. Recently, there have been calls for “indication-based” pricing systems, in which manufacturers are paid more when treatments are used for indications for which they have higher value (“high-value indications”) and less for indications for which they confer less benefit (“low-value indications”). Supporters hope that such a system will reduce prices for low-value indications but that prices for high-value indications will not increase. This expectation arises from a belief that manufacturers currently set uniform prices according to the value generated for high-benefit indications and somehow get patients who receive lower value to pay the same price.

CoI: multiple

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