Insights from a Veteran: A Chat with Helen Stevenson
January 23, 2019
In 2011, after years of working as a healthcare consultant abroad and then as Executive Officer and ADM for the Ontario government, Helen Stevenson founded Reformulary Group, an expert-led health care company focused on helping Canadians make informed choices related to medication and medical cannabis, and helping companies ensure plan sustainability. In this exclusive interview with 20Sense, Helen talks about the need for real-world evidence to drive the use and coverage of specialty pharmaceuticals.
Can you fill us in on what Reformulary does differently and how you add value?
We work with a core team of independent experts, including physicians and pharmacists, to review the evidence and create a single managed formulary for private payers. Because we work for employers, our analyses consider not only efficacy of particular drugs, but also treatment strategies to keep people out of hospital and boost productivity.
Specialty pharmaceuticals are the fastest-growing drug category in Canada. How would you characterize the challenges facing this category?
In a word, sustainability. As we all know, specialty drugs are expensive. None of the new drugs for cancer, for example, would meet our historical standards for cost-effectiveness. On the other hand, we can’t keep patients from new treatments that markedly extend life. So what do we do? We believe the answer lies in creating innovative funding agreements and obtaining real-world evidence to guide decision making.
What types of data should we be collecting?
In addition to tracking treatment success, we need to know how a drug is being used. For example, we may learn that patients are using a costly new drug as an add-on, rather than a replacement for other treatments. We need to track not only the performance of individual drugs, but of treatment combinations and of patients progressing among different therapies.
Real-world data also tells us whether patients are adhering to treatment. With most drugs, adherence typically falls off drastically after the first few months. With specialty drugs, adherence rates tend to be somewhat higher, but side effects and drug treatments for concomitant conditions can act as barriers.
We sometimes talk about data vs insights. How is Reformulary approaching insight generation with specialty pharmaceuticals?
Data is the what, insight is the why. We have been asked to look at patient behaviours for specific diseases, such as multiple sclerosis. What do patients typically use first line? Fifth line? Do they cycle through many different treatments? Using encrypted claims data, we have been able to follow patients’ prescription patterns over time. Separately, we mine claims data to identify health conditions within a plan population and then project the impact of pipeline drugs on health plans. Our next step will be to capture real-world outcomes directly.
The insights are the factors informing patient behaviours, which could range from access to coverage to market dynamics. We have been encouraging companies to use this intelligence to make business decisions about existing and pipeline drugs.
The pharmaceutical industry is currently undergoing reforms, with specialty and rare-disease drugs at the centre of the discourse. Can you comment on these developments?
Developments such as National Pharmacare could have varying impacts on the pharmaceutical industry. One of the more manageable ideas is a minimum formulary of drugs that would be covered automatically, whether through private plans, public plans, or other forms of subsidy. Plans would be required to cover drugs on the minimum formulary and could cover other drugs at their discretion. As for rare-disease drugs, I am a strong advocate for a national plan for these medications. In my previous role, I learned of families who moved to a different province to get better coverage for these drugs. We need a better solution than that. At the same time, we need to factor in affordability and sustainability into our drug plans and incorporate a system to collect and aggregate real-world evidence to help inform coverage decisions.
What advice about data and evidence would you give to specialty pharmaceutical stakeholders?
It’s important to access and use high-quality data. We firmly believe that using actual, unprojected claims data gives the most robust and fullest picture of current and expected usage patterns. When you’re launching a new product, real-world data and insights can help you understand the competition and enable you to adjust your strategy accordingly. If you’re a payer, you need to know how your clients are using a drug and how it’s working for them. You need data to make informed decisions.