Best ISPOR Ever!

The #ISPORAnnual meeting is always an exciting time at NPC, and this year’s edition was no exception. Our researchers shared NPC’s evidence-based perspectives in five unique sessions and gathered new knowledge from the 4500+ members of this important community. This year’s meeting felt particularly special because NPC board member, Jan Hansen of Genentech, chaired the meeting as ISPOR’s President and introduced ISPOR’s new CEO and Executive Director, Rob Abbott .

Each session presented an opportunity for sharing perspectives, expertise, and counterpoints to prevailing wisdom, including the first plenary where I joined NICE CEO Samantha Roberts , CMS Deputy Administrator Meena Seshamani , and legendary cost-effectiveness evaluation researcher Michael Drummond from the University of York. As meeting attendees reflect on the many terrific sessions, I hope everyone will carry some important takeaways into ongoing discussions about the role of the #HEOR community in research and policymaking.

For most policymakers, the focus of promoting patient access to treatments has been squarely on price setting for drugs, as we’ve seen with the government price controls being implemented as part of the IRA. But when I worked in government, we saw affordability as the price patients paid at the pharmacy counter, largely dictated by which insurance card they have in their wallet. Here’s what these policymakers should consider:

• Three of the largest companies in the U.S. are insurers that own PBMs and extract value from medicines to take profits and/or subsidize other businesses.
• At the same time, hospitals and their contract pharmacies are buying drugs at reduced prices intended for low-income patients in the 340B program, and selling them at higher prices to commercial insurers as a means to cross-subsidize other services.
• The HEOR community can play an important role in appropriately measuring the value flowing out of prescription drugs to make OTHER health care services more affordable.

For the biopharma industry, there are additional takeaways to avoid the trap of underestimating the downstream impact of the IRA’s price-setting provisions in delivering treatments and cures for patients:

• There remains so much uncertainty about how the IRA’s price-setting process will work, but we can ascertain that the nine-year window before price controls kick in will discourage drug companies from conducting clinical trials to pursue additional indications for already-approved drugs.
• Provisions in the IRA will likely skew R&D budgets away from pursuing small molecule drugs and additional designations for orphan drugs.
• These changes will likely have deleterious impacts on vital areas of our industry, including cancer care, rare disease treatments, and our burgeoning population of seniors (or soon-to-be-seniors like me).
• However, CMS does have significant regulatory discretion in implementing this law, flexibility that could be deployed to tell the marketplace they won’t be negotiating prices for drugs being developed to address unmet medical needs.
• Ultimately, it is our hope that CMS builds a transparent and predictable process that engages with patients, experienced clinicians, and manufacturers early in the process and before any initial offer is made.

This year’s ISPOR meeting made it clear that we’re at a watershed moment for the HEOR community. More and more payers are using ICER’s evaluations—mainly as a cudgel for rebates—and their current assessments leave too many elements of value on the cutting room floor. At the same time, the U.S. government is trying to build a new model, under incredible pressure in a highly politicized environment. We’ve barely scratched the surface of what we can learn from real-world evidence, and we’re experiencing a surge of medical innovation via gene therapies and other cures that we haven’t agreed how to pay for or properly value.

That’s why ISPOR—The Professional Society for Health Economics and Outcomes Research is so critical today. The people who presented during meeting sessions understand the importance of new treatments and the need for continued investment. We need their input to balance the present tension, and there hasn't been a time when fair, rigorous science was more needed from the HEOR community.

I think the community is up to the challenge and I’ve never been more encouraged about the future of HEOR professionals than when I stepped off the plenary stage. Later that day, I joined students and young professionals at the NPC-sponsored Career Catalyst Reception for a thoughtful and energetic panel with Inmaculada (Inma) Hernandez , Sean Sullivan , and Julie Patterson around shaping the future of health care policy with pharmacoeconomics. The crowd gave us all life and I was particularly impressed at the eagerness of our young audience to tackle the most pressing issues facing our industry today.

ISPOR is a special conference and this year’s event could not have come at a more critical time. The future of HEOR is undoubtedly bright, and I invite everyone I met with—old and new—to stay in touch.