Link cancer drug prices to patient benefits, says Express Scripts

One of the most powerful US health insurers is calling on pharma companies to link the prices of their cancer drugs to how well they work in different patients.

Dr Steve Miller, chief medical officer at Express Scripts, says it makes no sense for cancer drugs to have the same price no matter what cancer they are treating, as the data shows some tumour types respond much more than others.

Miller has emerged as the most influential and outspoken advocate for price controls of medicines in the US (most notably his battle with Gilead over hep C drug prices) and says the continued rise in prices, particularly in cancer, cannot continue.

His demand for pay-for-performance deals is in response to many cancer and specialist drugs costing more than $100,000 per patient a year.

Talking to the Wall Street Journal (WSJ), Dr Miller pointed to Tarceva, the Roche and Astellas drug which is licensed for use in lung and pancreatic cancer, but which shows far less benefit in the latter. One clinical trial showed Tarceva extended the median survival of pancreatic cancer patients by less than two weeks versus placebo. By contrast, a trial in lung cancer showed it extended overall prolonged survival in these patients by about three-and-a-half months compared to chemotherapy.

"One of the big frustrations has always been people paying top dollar for drugs that aren't always giving them the best response," Dr Miller told the WSJ. "If pharma is truly sincere about wanting value-based reimbursement, we now have the sophistication to do that."

Despite using Tarceva as an example, Miller wouldn't say which drugs Express Scripts was targeting for pay-for-performance pricing. He did confirm, however, that it was already discussing such deals with pharma companies, and that these could take effect from 2016.

Experience in UK and Europe

Talk of linking prices to patient outcomes has been around in pharma for many years, but establishing a clear and fair link between the two is far from straightforward.

Nevertheless, many European countries are trying out different pay-for-performance schemes, including the UK, France and Italy.

In the UK, then health secretary Andrew Lansley tried to introduce a Value Based Pricing (VBP) system for pricing all new innovative drugs in 2010, but the idea was eventually rejected by the government and pharma as too complex to implement.

While a whole-system approach has been abandoned in the UK for now, the idea of linking price to performance has not gone away. This is because most agree that the UK's pricing and market access system is not fit for purpose – something which the government-sponsored Accelerated Access review will address.

Meanwhile some pharma companies are taking proactive measures on pricing. In January, shortly after a number of drugs were de-listed from the Cancer Drugs Fund, Roche announced it was introducing 'multi-indication pricing' for Avastin – a system very similar to that being proposed by Express Scripts in the US.