With companies under increasing pressure in Germany to offer payers rebate deals around patented drugs, some are seeking to avoid straight price-cutting through providing added value elsewhere. In our third snapshot of the changing reimbursement landscape in Germany, we look in more detail at Wyeth's compliance scheme around rheumatoid arthritis drug Enbrel.
Wyeth signed the pact with Germany’s third-largest payer, Taunus BKK, and one year on, it seems to be working. Sales of the injectable rheumatoid arthritis drug etanercept (Enbrel) have shown a "generally positive" trend, according to consultants Booz & Co., as opposed to a "generally negative/stagnating" trend for sales of Abbott Laboratories’ competitor, adalimumab (Humira), at the same payer. "
As such, according to Booz, "this scheme is one of the rare examples showing a clear improvement in uptake following implementation," says Rolf Fricker, VP and Partner. "It’s too soon to say it’s paid off already, but it’s on its way to pay off in the near future," he surmises.
Indeed, competitive pressure from Humira was one key driver behind the deal, which sees Wyeth funding homecare visits to RA and psoriasis patients by qualified nurses, a telephone-line support service, and the promotion of regular patient communication about RA treatment—including tips on how to self-inject, and the importance of maintaining therapy.
Wyeth probably has to provide some sort of discount on Enbrel too, since "by law, the basis of any deal between a sick fund and drug manufacturer is [classified as] a rebate contract," according to a Wyeth Germany spokesperson, although declining to confirm an actual discount on the drug’s price.
Discounting isn’t the deal’s focus though; Booz estimates that the support program costs the company approximately €500 per patient per year anyway. That’s probably worth it, however, since injectable biologics have abysmal compliance rates. About a third of prescriptions are discontinued within the first three months, according to Booz; the drugs’ high value means it makes sense for sponsors to pay to increase the probability that patients stay on a treatment for even just six months longer.
Stronger sales are just one of this deal’s benefits to Wyeth. Taunus’ significant publicity around the program is another. Direct-to-consumer advertising by drug manufacturers is banned in Europe, but in Germany at least, there's nothing to stop sick funds from contacting patients and doctors about particular treatments they support.
Another nice side-benefit of the program for Wyeth is reduced use of parallel imports—cheaper versions of Enbrel sourced from lower-priced European countries and re-sold in Germany. Pharmacists are encouraged, via computer software, to dispense the original product rather than an imported version—and the deal is designed such that it’s more economical for them to do so, according to Wyeth and Taunus. That means less time and trouble spent "dealing with foreign drug packaging" asserted Taunus’ CEO Udo Sennland when the deal was announced.
All this keeps Wyeth happy, and Taunus BKK isn’t missing much, since it wouldn’t be able to rely heavily on cheaper imports anyway because of volume and supply issues. (The health insurance funds are obliged to invite parallel importers to enter into rebate contracts, too, but as yet none appear to have done so.)
Small wonder, then, that Wyeth has since expanded the deal to over 100 other German payers, some of which have eliminated patient co-pays for Enbrel to further encourage drug uptake.
[For a full analysis of the changing German reimbursement landscape, see the next issue of IN VIVO.]
--Melanie Senior (m.senior@elsevier.com)
