Beginning of the week, MArS was again at the University of Applied Sciences Ravensburg-Weingarten. The topic was this time “innovative organizational structures”. The course included the way we work including digital coffee breaks, family calendars, etc. Was great received – and looking forward to the next course. More on our way to work here.
Great start into 2020 with MArS!! We have six presentations accepted at this year’s conference of the German health economists conference (DGGÖ).
The MArS team wishes all a merry and peaceful Christmas and a great start into the New Year!!!
MArS attended the Medical valley Forchheim symposium on the market access pathway for new digital solutions (“apps”) into the statutory health care market. The new law will come into effect January 1 2020. Still open are the templates for the BfArM consultation and the price negotiation frame with the Head association of the statutory health insurance funds (GKV-SV). For the BfArM the regulations can be expected as the new law §33a para. 3 SGB V RefE is now publicly available. In case clinical evidence for a (patient) benefit is proven the app can be included in the BfArM registry / database, if that is not the case this can be provided within the first year of launch.
For the price negotiations MArS expects the regulation frame to be similar (but adapted) as within the AMNOG process. Core drivers will be the European prices (incl.out of pocket cost) as well as the clinical evidence on the product and comparable products. The template for the price negotiations are expected in the next few weeks. The arbitration board is not yet defined and built but is expected soon.
MArS offers the digital industry the experience in the process and contacts with German payers, the BfArM and especially with price negotiations with the GKV-SV. Core services to be provided will be Communication with payers, Pricing – planning, research, design, implementation and Price negotiation.
Sustainability is one of MArS’ core values! Hence MArS has defined four rules of behaviour on which all MArS members work, travel and live.
- “Notified Bodies”, which previously carried out the certification, are now accredited. Currently there are only 7 companies that are allowed to certify from 20.5.2020. The small number would delay the certification considerably.
- Previously, the state authorities were responsible for monitoring medical devices. From 25.5.2020, this will fall within the remit of the BfArm, i.e. the BfArm itself can withdraw medical devices from the market.
- British Standard Institution issues 2/3 of CE certificates in UK and is now accredited as Notified Body in Germany
- Legally binding: alternative compromise ideas with more scope for the member states are currently being developed for this purpose.
- Judicial redress: would an EU HTA assessment be an administrative decision or a preparatory measure to a decision?
- Scope: newly authorised medicinal products (proposal D/F: selection of 10 products per year); medical devices (proposal D/F: selection of some high-risk products)
- Dispute resolution in proceedings: is a simple or qualified (55 % of Member States with 65 % population) sufficient?
- Normally, the Council negotiates between Parliament and the Commission; this is the first time that parliament mediates between the Commission and the Council.
- Theoretically, failure would be possible, but would be a major setback for the EU.
- Agreement between Commission, EU Parliament and EU Council (“Trilogue”) expected in 2020
- Depending on how long the procedure will last, the question is which country as President of the Council will end the procedure: 1. HY 2020: Croatia; 2. HY: Germany
The availability of Zolgensma in the USA has also fuelled the price discussion for new drugs in Germany. Zolgensma is approved in the USA for the treatment of children with spinal muscular atrophy (SMA) and can (potentially) cure the disease. The drug has not yet been approved in Germany – European approval is expected next year.
Now there are two big discussions in Germany: On the one hand the handling of drugs that have not yet been approved in Germany and on the other hand the pricing of these drugs.
The handling of drugs prior to approval is clearly regulated in the Drug Hardness Ordinance (AMHV) on the so-called Compassionate Use Programme and provides for a cohort programme care of German patients. The drug is made available free of charge! The individual case regulation, which is now also criticized by the health insurance companies, is also clearly regulated by the so-called “Nikolaus” judgment from the year 2005 and is especially made for life-threatening diseases.
As far as the price is concerned, it should be noted that 1) SMA only affects 500 patients throughout Europe, i.e. approx. 80 patients in Germany (!) – so with 100 insurances on average 1 patient per insurance – and 2) without an expectation for high profit in such ultra orphan diseases, no new therapies and medicines will be available in the future either, as the research and investment incentives are then no more given.
MArS supports you with the optimal reimbursement strategy, pricing for the D-A-CH market and, of course, in a possible early contact and discussion with the statutory health insurance funds.
Acquired thrombotic thrombocytopenic Purpura (aTTP) is a life-threatening ultra-orphan disease with a reported annual incidence between 1.5 and 6.0 cases per million in Europe and mainly affecting otherwise young and healthy adults aged 40 years on average. The goal of this study was to assess the incidence of aTTP in Germany. A systematic review was performed to determine the published evidence on the aTTP epidemiology in Germany. To obtain additional evidence on the proportion of aTTP cases within the national Thrombotic Microangiopathy (TMA) population a hospital-level study was performed, using a retrospective data collection approach. Diagnosis of aTTP was confirmed if ADAMTS13 level were < 10% and/or the medical records explicitly mentioned aTTP diagnosis. The aggregated hospital data were then projected to the national level using logistic regression techniques.
The determined annual incidence of newly diagnosed aTTP cases and the overall annual incidence of aTTP episodes in Germany confirm the ultra-orphan character of aTTP.
Download the full article here:
Miesbach, W., Menne, J., Bommer, M. et al. Incidence of acquired thrombotic thrombocytopenic purpura in Germany: a hospital level study. Orphanet J Rare Dis 14, 260 (2019) doi:10.1186/s13023-019-1240-0
Ever wanted to understand game theory?
Perfect timing with the availability of infocomix. Within „game theory“ the authors were able to transfer the basic concepts of game theory in an easy and non-mathematical way! Fun to read also for experienced game theorists!!
We at MArS apply game theory in our MArS negotiation boot camp to prepare clients optimally for the negotiations with payers! Contact us!!!
The book is available also on Amazon.
Great honor to have been invited to a Pharmacoeconomics workshop in November to Cairo, Egypt. Dr. Walzer presented the situation on evidence-based medicine, HTA and reference pricing in Europe as well as the introduction into value-based pricing in the context of health economics.
The course was well organized by Accsight and their team with a very open-minded Egyptian payer audience.
Big discussions paving the way for a new Egyptian health care system by 2030!!!