During the height of the first wave of the global COVID-19 pandemic, Inbeeo tracked the impact that the virus was having on global market access activities. From the 9th April to the 14th May, we reviewed the market access landscape in a number of countries and created an interactive dashboard on our website, which we updated twice weekly to inform viewers of the current situation regarding HTA, Pricing and Reimbursement. We saw some great engagement with the dashboard and it was even picked up in the Industry press.
Two months on and the virus may still be airborne but the dust kicked up from that initial first wave has settled somewhat (here in Europe at least). As many of us try to resurrect our summer holidays, I have found a few seconds to breathe and even contemplate… So with all the data sitting in an excel file and a beer in my hand (in case you are wondering I don’t make a habit of drinking on the job, it was our early finish Friday), I put together a quick data dashboard to show the Market Access landscape evolution over those 6 weeks in April and May. The resulting interactive data dashboard is embedded below so please do have a play.
Now, by the time I had done this my beer was empty and predictably for a Friday evening so was my brain. So refreshed and ready to go on a Monday morning I picked this back up to see what we can take from this once-in-a-lifetime (hopefully) event in terms of the impact it had on pharmaceutical Market Access activities around the world.
An Initial Snapshot of Market Access Activities
Let’s first take a look at ground zero for this dataset, our first Dashboard on the 9th of April at the height of the outbreak in Europe.
A snapshot of the landscape on this day shows two countries with significant Impact, five countries with some Impact and six countries reporting no Impact on Market Access activities. Perhaps not surprisingly, those countries that were suffering from the highest incidence of COVID-19 cases were also seeing the biggest impact on their Market Access activities (illustrated in the graph below). Both Spain and Belgium had completely halted all activities and Italy had just begun to restart some activities after being previously shut down. However, nearly all countries were having to adapt to a new way of working with offices closed and pricing and reimbursement committee meetings being held virtually instead of face-to-face.
Cumulative cases as of 09/04/2020 taken from COVID-19 Dashboard by CSSE ant JHU
Identifying the Positive Trends that Emerged
From here we could go through events week-by-week, detailing where and what happened, but I really do believe a picture (or in this case an Inbeeo data dashboard) paints a thousand words. So instead, I want to focus on the positive aspects that I saw come out of this period.
When we decided as a team to build this dashboard our original aim was to focus on the delays in assessments and P&R decisions caused by COVID-19. However, it quickly became apparent that while the disease was having a huge impact on agencies, responses were rapid, dynamic and should widely be praised. There were many proactive and positive activities that HTA bodies were undertaking to help prioritise COVID-19 topics, ensure as little disruption as possible in core activities, and foster a global collaboration to fight the disease. We felt compelled to capture these positive aspects by adding a COVID-19 Response and Activities section to our dataset. It is from this information that I have identified my three key takeaways from looking on the bright side.
1) Priorities Had to Change, and Change They Did, FAST
As much as you can praise those agencies who were able to carry on as normal with no apparent impact to their market access activities (Germany always seems to get it right), it also pays to recognise those who did not have that luxury but who were able to adapt. Agencies were able to grasp the magnitude of the situation, realise that with only finite and reduced resources (with HCPs dedicating themselves to the front-line), business as usual was a non-starter, and rapidly implementing a contingency plan that prioritised the most pressing and urgent needs.
For example, HAS (France) established a list of priorities starting with treatments intended to manage the COVID-19 epidemic. Registrations of new drugs in oncology, paediatrics or all drugs responding to an unmet medical need in a serious illness were given second priority, with extensions of indications being de-prioritised and assessed according to a simplified instruction procedure. Other agencies hit hard by high incidence of infections in their countries also actively prioritised COVID-19 activities including NICE (England), AIFA (Italy), INAMI (Belgium), SMC (Scotland).
2) The Impact was not as Long Lasting as Some Might have Thought
By the time we started our dashboard on the 9th of April, Italy had already restarted pricing and reimbursement decision-making with AIFA publishing the decisions from its virtual meeting that very day. Yes, Italy was one of the first countries hit, but it was hit hard. Cases still numbered over 4000 a day so to get back up and running so quickly should be applauded.
We see this trend in other areas, with our dashboard map showing a progressive increase in market access activities. By the 14th May HTA agencies in most countries were operational and undertaking core activities. Of course, some agencies were still experiencing delays in areas, but many of these were undertaking additional COVID-19 related activities such as preparing rapid treatment guidance or developing COVID Portals for HCPs on their websites. The G-BA (Germany), DMA (Denmark) and CADTH (Canada) managed to continue operating with minimal impact on their core activities while also undertaking additional COVID-19 activities
3) A Spirit of Collaboration and Openness came to the Fore
Finally, there were a number of events that really highlighted the willingness to share information and collaborate between agencies. A few of these are highlighted below:
- NICE (England) – Waived their normal licensing requirements for international reuse or reproduction of content for all COVID-19 products and also offered free fast-track scientific advice for researchers developing novel diagnostics or therapeutics for COVID-19
- DMA (Denark) – A group was formed that will continuously update a public list of worldwide studies and research on medicines for COVID-19
- EUNetHTA (Europe) – Offered support to international (WHO, OECD, ECDC) and national organisations where the remit and resources allowed. Committed to the non-duplication of any work already done and ensuring that there is no interference with work others were already conducting
Healthcare systems hit by the pandemic are under great strain both in terms of finance and resource. This has an impact on market access and pricing for healthcare products. As we have seen, COVID-related products have understandably gained a higher priority and a higher perception of their value. Outside of this disease area, strained healthcare systems will scrutinise more thoroughly the value of new (and existing) products. And this is probably here to last.
Keep you eyes peeled for our next blog post where Herve will be looking to the future examining the market access measures triggered by COVID-19 that are here to stay