Using Evidence To Improve Access

April 22, 2024

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As Director of Pharmaceutical Partnerships and Operations at GreenShield, Canada’s only national non-profit health and benefits provider, David Greiss is committed to GreenShield’s mission of enabling better health for all. In this role, he oversees a team working with the pharmaceutical industry to ensure the sustainability of private drug plans. In a world of soaring drug innovation and matching costs, that’s a tall order to fill. But one that David is well-prepared to take on.

Formerly a Team Lead at the pan-Canadian Pharmaceutical Alliance (pCPA), David has been working in drug reimbursement for over seven years – and is in it for the long haul. “Drug reimbursement and market access sit at the intersection of my main areas of interest, namely health policy and economics,” he says, adding that he particularly enjoys the nuances of making listing decisions.

The nuances become especially complex around specialty medicines. To assist in the decision-making process, David and his colleagues developed an internal framework for using real-world evidence (RWE) in drug reimbursement. Specifically, “when high-quality clinical trials are missing, we use RWE to round out our listing decisions around innovative therapies, using different tools to help weight the evidence.”

Using such tools, GreenShield has worked with several pharmaceutical companies to create RWE initiatives and outcomes-based agreements (OBAs). This experience “gives us insight into the outcomes most valued by patients so we can tailor our programs accordingly,” says David. For example, “for therapies with only Phase 2 data, we can expand the eligibility criteria to more patients through innovative agreements that spread the risk between ourselves and our manufacturer partners.”

 

“Working on RWE and OBAs gives us insights into the outcomes most valued by patients.”

 

Having demonstrated the viability of collecting medical information from forms and using the data to make decisions, David sees the next step as “making all these processes more efficient, more automated, and easier to analyze.” With these outcomes in mind, GreenShield plans to create a digital prior authorization system, “which will help us understand the outcomes of new drugs that we reimburse to our plan members.”  By having access to better insights, GreenShield will be able to create better health solutions designed around the needs of plan members.

Undaunted by the complexity of the tasks, David says he looks for “areas where there is common ground among all the stakeholders involved. I focus on collaboration and bring an entrepreneurial spirit to my work.”


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