Pricing & Reimbursement Report

22 December 2017

This report highlights pricing and reimbursement expectations for some key drugs in development. It also covers recent trends like the impact of Brexit on the UK’s pricing watchdog, NICE, and of Foundation Medicine’s diagnostic approval.

Headlines include:
• EU Brexit negotiations could see UK become less favoured pharma market but NICE to remain pricing model – experts
• Foundation Medicine’s F1CDx could signal some reimbursement hurdles for in-house panels at large centers with its potential CMS coverage- experts
• Novartis/CMS value-based reimbursement model for Kymriah in ALL likely to become basis across private payers; deviations possible with other CAR-Ts, indications - experts
• SAGE’s brexanolone faces PPD uptake challenges due to potential reimbursement issues despite physician enthusiasm – experts
• Alexion’s Soliris for myasthenia gravis to see limited US uptake but niche acute use over Biogen’s Rituxan – experts
• Vertex’s tezacaftor/Kalydeco combo likely to be priced similar to Orkambi in CF, reimbursement coverage may thrive due to lack of competition
• Ablynx’s caplacizumab likely to see USD 100k+ price tag in aTTP; minor US payer pushback expected unlike in Europe – experts