PHP141 - Canadian Private Payers’ Perceptions and Expectations of Submission Requests for Drug Reimbursement Submitted by the Pharmaceutical Industry

Abstract

To identify, from a private payer’s perspective, the required elements to include in a pharmacoeconomic model and a budget impact analysis and compare them to that of the public payers’ requirements. The secondary objective was to determine the preferred components to present in a submission regarding private payers. A survey was sent to 21 submission reviewers from 14 private insurance companies offering drug reimbursement, using an online survey builder, KwikSurveys. The survey included 15 questions divided in 5 sections: General information, Clinical information, Pharmacoeconomic evaluation, Budget impact analysis and General appreciations. Nine reviewers from eight different companies, which represent 80% of the Canadian private payer market shares, responded to the survey. Results showed that 67% of participants follow the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines for economic evaluations. 88% of participants prefer a cost-effectiveness evaluation, while 75% prefer a cost-benefit evaluation. 100% of the participants would like direct drug costs and the indirect costs related to loss of productivity due to reduced working capacity to be included in the pharmacoeconomic model. 75% would like the costs to employer to hire and train replacement worker, the costs of premiums paid to, as well as benefits received from, private insurers to also be included in the model. 63% of the participants would like to see a population data-based model for their budget impact analysis. Similarly, 63% of the participants prefer a time horizon of 3 years for the budget impact analysis. The parameters to be considered in a submission sent to private payers are different from public payers’ requirements. The perspective of the pharmacoeconomic model should be that of a private payer and the budget impact analysis should only consider a population covered by private payers.