One PSP challenge, four big ideas
January 23, 2020
The two imperatives of PSPs—delivery of vital treatment support services and financial sustainability—exist in a state of mounting tension. Changes in patient, prescriber and payer roles are already rumbling under this shifting terrain. By all appearances, a change in the whole model of specialty medicine care is on the way. Here, we explore four possible PSP models of the future.
BIG IDEA #1: The broad-spectrum PSP
The “one drug, one PSP” model yokes each PSP to a specific drug, but the industry has begun to question this paradigm. Instead of developing separate PSPs for each product, why not develop a PSP to cover all specialty medicines (or a whole drug class) within a therapeutic area?
One group, Biosimilars Canada, an association representing some of Canada’s biosimilar makers, has done just that. Earlier this year, the association launched its own PSP to provide support services for member pharmaceutical companies.14 Such drug-agnostic PSPs stand to lower costs and increase consistency across indications and products. Extending this idea to its logical conclusion brings us to the “universal PSP,” meaning a flexible PSP that can shape-shift to suit all comers.
In a variant of this approach, PSPs could make their services available across an open network of clinics, rather than tethering services to specific sites. Such an infrastructure would free up patients to select the clinics that are most convenient for them, and avoid having them move sites if their prescribed medications changes – as is the case today with some PSP models. On the flip side, an open-network model could consolidate services currently duplicated by several clinics in a single neighbourhood. The model would also make life easier for the vast number of patients being mandated to switch from originator biologics to biosimilars—especially in provinces such as Alberta and BC, which have recently instituted biosimilar switching policies.
One size fits all?
A year into Biosimilars Canada’s PSP program, Jim Keon , president of the association, weighs in. Some of our members already had PSPs in place, so they did not leverage this program. Right now, we have two biosimilars participating in the program, with more to come. We are open to non-member companies participating as well.”
“Though it’s still early days, feedback from payers and prescribers has been very positive. Stakeholders have been concerned about the proliferation of programs, which adds complexity and costs, and view this solution as a good one.”
“We mitigate costs through economies of scale, but more importantly, we provide a first-class PSP that patients can use with confidence. To account for differences between drugs, we offer a full suite of services that different companies [drug manufacturers] can tailor to their needs.”
BIG IDEA #2: Collaboration on PSPs
Picture this: a group of manufacturers band together to build a shared PSP across a therapeutic area, such as rheumatoid arthritis or inflammatory bowel disease. They use a single PSP vendor (selected through a request-for-proposal process), which uses its own pharmacies to deliver services. The manufacturers also merge their distribution architecture, in line with, for example, the unified model offered today by the Canadian Pharmaceutical Distribution Network for hospital drug distribution.15 Such consolidation of resources would bring down costs, which manufacturers could split based on usage. To make the model work, participants would need to take full advantage of the economies of collaboration, which could include data sharing.
BIG IDEA #3: As new centre of PSP gravity
Who drives the creation and operation of PSPs? Manufacturers, of course. But does it have to be this way? Could PSPs’ centre of gravity shift to another locus?
One could argue, for instance, that PSPs fill holes in the healthcare system, so the system should step up and support them. In a nod to this idea, Ontario’s Ministry of Health and Long Term Care (MOHLTC) has suggested that provincial oversight and funding of private infusion clinics – often part of PSP service delivery – could help support high standards across these clinics.16 Prescribers, for their part, receive several indirect benefits from PSPs. Most PSPs handle the paperwork for patient enrolment and take charge of laboratory testing, lifting a sizable load off physicians’ shoulders.5 PSPs also support treatment success by speeding up access and improving adherence, which prescribers recognize as a game changer. Thomas Walters, a pediatric gastroenterologist at SickKids Hospital in Toronto, has noted how manufacturer-sponsored PSPs have improved treatment outcomes and made his own job easier.17 What if prescribers exerted a more direct pull on PSP development? As an example, physicians have justifiable concerns about the logistics of interfacing with a different PSP for each drug. Based on such feedback, could PSP design be tailored to better meets prescribers’ needs? In fact, this shift is already underway, with a number of stakeholders working closely with prescribers to pilot and test how such models might work, and drive increased benefit to their patients.
BIG IDEA #4: The turbo-charged PSP
Given the large investment in running a PSP, it makes sense to get the highest possible ROI from the effort. Data collection already plays an important role in today’s PSPs, but there is room to go further—like ramping up data on health outcomes. The judicious use of technology could also help integrate PSP outputs with data from other sources, such as hospital data, claims data, and unstructured data within the health system, thus making the information more valuable to more people.
It goes without saying that such “fortified” PSPs would benefit all parties. Prescribers could better understand their patients’ trajectories, including the pain points. Payers would gain insight into which drugs work for which patients, enabling them to allocate their resources even more equitably. These same insights could help manufacturers make informed business decisions and reduce strategic risk. Ideally, all the data would come together to help get patients on “the right drug at the right time.”
The future of PSPs depends on bold, big-picture thinking. As stakeholders put their heads together, who knows what other ideas will bubble up? The next few years will be interesting.
References:
14 - Biosimilars makers in Canada to launch patient support program. Gabi online. January 11, 2019. www.gabionline.net/Biosimilars/General/Biosimilars-makers-in-Canada-to-launch-patient-support-programme
15 - Canadian Pharmaceutical Distribution Network. https://cpdn.ca/
16 - Briefing Note. The Globe and Mail. August 8, 2017. https://www.theglobeandmail.com/files/editorial/News/remicade/ontario-doc.pdf
17 - Walters T. Presentation at the 2017 IHE Biosimilars Forum. https://www.youtube.com/watch?v=w-LvYlW9vCE