Payers will often look to disease analogs when making pricing and coverage decisions. These disease analogs can inform the level of rebates, need for prior authorization/utilization management, and the drug’s cost sharing tier. Traditionally, however, disease analogs are selected on an ad hoc basis. In a recent JMCP paper titled “A structured approach for identifying disease analogs for pulmonary arterial hypertension,” I and co-authors Karim El-Kersh, Nadine Zawadzki, Anna Watzker, Shurui Zhang, Dhruv Dalal, and Dominik Lautsch developed a quantitative approach for creating disease analogs and apply this approach to the pulmonary arterial hypertension (PAH). The abstract is below:
Drug manufacturers often use disease analogs to describe diseases—particularly rare diseases—to payers, policymakers, and stakeholders. However, these comparisons are typically anecdotal. We propose a 4-step, systematic approach to identify disease analogs based on prespecified metrics and apply it to a rare disease, pulmonary arterial hypertension (PAH), as a case study. When there is limited knowledge of a rare disease, such as PAH, the application of the systematic disease analog approach presented can help managed care pharmacists leverage their existing knowledge and perspectives applied to other conditions to inform coverage, tier placement, and pricing decisions.
You can read the full article here.
