Turning the tide on cancer drug costs

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Summary: At The Economist’s War on Cancer 2015 event on 20 October 2015 (http://www.economist.com/events-conferences/emea/war-cancer-london), EY’s Silvia Ondategui-Parra joined the panel discussion “The patient/payer debate—balancing clinical need and affordability.” The panel explored the ongoing tension between the soaring cost of cancer drugs and governments’ ability to fund them and raised the question, do we need an entirely new pricing model? This EY infographic was developed to highlight some of the key trends driving the debate.

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Prescription Medicines - Costs in Context - October 2018

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This document discusses the costs and context of prescription medicines. It notes that while prescription drug spending is a small percentage of total healthcare costs, certain patients face rising out-of-pocket costs. It also outlines the significant costs and risks of developing new medicines, with the average drug taking over 10 years and $2.6 billion to develop. The document proposes reforms to help lower costs for patients while supporting continued research and development of new treatments.

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This document discusses the costs and affordability of prescription medicines in the United States. It notes that while spending on prescription medicines accounts for only 14% of total health care spending, patients face high and rising out-of-pocket costs for medicines. While most medicines sold in the US are generics, brand name medicines face significant price negotiations and rebates paid to insurers and pharmacy benefit managers that often do not lower costs for patients. The document outlines reforms to make medicines more affordable and accessible for patients.

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This document discusses the costs of prescription medicines in the United States. It notes that while brand medicine prices have risen 1.7% in 2019, in line with inflation, many patients still struggle with costs. It also discusses that prescription medicines make up only 14% of total healthcare spending in the US. Finally, it summarizes efforts by PhRMA to make medicines more affordable and accessible for patients.

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Prescription Medicines Costs in Context November 2019

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This document discusses the costs and context of prescription medicines. It notes that while prescription drug spending is a small percentage of total healthcare spending, patients often face high out-of-pocket costs. It outlines the significant costs and risks of drug research and development. The document also describes the role of generics in reducing costs over time and how rebates and discounts do not always lower costs for patients.

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This document discusses insulin costs and affordability challenges for patients with diabetes. It notes that while list prices for insulin have increased, net prices have declined due to rebates and discounts. However, more patients now face high deductibles and coinsurance based on list prices, increasing their out-of-pocket costs. It recommends several policy solutions to improve insulin affordability like requiring insurers to pass on rebates, capping out-of-pocket costs, and expanding access to lower-cost insulin options.

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This document summarizes information from a report about prescription drug costs and spending in the United States. It notes that 53 new medicines were approved by the FDA in 2020 and discusses trends in drug spending growth rates remaining in line with overall health care spending increases. However, it also outlines challenges patients face in affording medications due to high deductibles, coinsurance, and other out-of-pocket costs not reduced by negotiated rebates and discounts. The report examines spending and policy issues across the entire U.S. health care system that contribute to the complex drug pricing landscape.

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Prescription Medicines Costs in Context January 2020

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This research explores the feasibility of introducing an Outcome-Based Payment approach for new cancer drugs in England. A literature review explored the current funding landscape in England, the available evidence on existing OBP schemes internationally, and which outcomes cancer patients value most. Two focus groups and an online survey with patients and carers, as well as interviews with NHS and government stakeholders, healthcare professionals, and pharmaceutical industry representatives, provided additional evidence on the feasibility and suitability of OBP schemes

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The theme for this quarter is rearrangement. The loss, or potential loss, of Russian oil and gas supplies is forcing producers, refiners and traders to rethink the flow of crude oil and refined products from the wellhead to the gas pump in light of sanctions, potential sanctions and the risk of reputational damage. Countries, companies and consumers will all be searching for ways to adapt, and the outcome of the race to bring alternatives to market could alter the global energy landscape for years to come. It is likely crude oil and LNG prices will remain elevated for some time. The process of diverting Russian oil through countries unwilling to sanction it will take time and there is little indication OPEC members are willing (or able) to increase production to make up for the loss of Russian crude. Spare capacity sat at 3.7 mbpd at the end of 2021, just above where it was in January 2020. Currently, sanctioned Venezuelan and Iranian production (about 3 mbpd below their peak) could fill the gap, but political and commercial obstacles remain. At today’s prices, US shale production is attractive, but the fastest the industry has been able to grow is between 1mbpd and 2mbpd per year. The LNG infrastructure was already stretched before the war in Ukraine and there is little prosect of finding new supplies soon. As the largest buyer of Russian energy, Europe will be the epicenter. There is a deeply embedded bias there in favor for renewable energy, and the current crisis is certain to result in an all-out effort to accelerate the build-out of wind and solar power. The capacity to add new green energy is limited though by the project pipeline and supply chains for solar panels and wind turbines, and it is likely that much of the shortfall will be made up with the new LNG infrastructure.

EY Price Point: global oil and gas market outlook

As the last quarter of the second pandemic year draws to a close, we continue to see heightened contrast between the medical and economic points of view. While COVID-19 cases are close to their all-time highs, so are equity prices, and a leading investment bank declared (on 2 December, 2021 after the Omicron outbreak in South Africa) that it was “optimistic about the possibility of a vibrant 2022.” When news of the variant hit in late November, the markets were rocked by the prospect of yet another round of local mobility restrictions and an interrupted return to normal international travel patterns, on top of the Biden Administration’s announced release of 50 million barrels of crude from the US Strategic Petroleum Reserve. So far though, with OPEC standing by its planned gradual return to normal production, oil prices have stabilized, albeit below where they were in mid-November. Henry Hub prices, always at the mercy of the weather, responded predictably to a warmer-than-normal early winter in the US, falling from US$6.60/MMBtu in early October to below US$4.00/MMBtu by mid-December. In Europe and Asia, following a short reprieve at the start of the quarter, piped natural gas prices have spiked again on concerns triggered by Russian troop buildups on the Ukraine border and uncertainties surrounding the Nordstream 2 pipeline. Looking forward, OPEC and the U.S. Energy Information Administration (EIA) in their last forecasts of the year both projected that 2022 oil demand would be above what we saw in 2019. Although time will tell if those forecasts are realized and other events could intervene, the response to new virus outbreaks is well-practiced and the trade-off between public health and economic reality has tipped toward a cautiously optimistic view.

EY Price Point: global oil and gas market outlook, Q2 April 2021

The theme for this quarter is governed. Apparent market balance at prices that could be sustainable is the product of calculated choices by market leaders and the cooperation of those who follow them. Economics played their customary role as well, with capital scarcity in North America taking about 2 million barrels per day out of the market, about half of the remaining gap in demand. While inventories are close to their pre-COVID-19 levels, there is still uncertainty. The resolution of the pandemic is in sight, but timing is unclear. Vaccine distribution in the US is having an impact but Europe is struggling to contain a third wave of infections. The taps have opened on economic stimulus, but it remains to be seen if policymakers have done enough or if they have overshot the mark. The shape of the crude oil forward curve has fundamentally changed since the end of the last quarter. In late December of last year, the Brent forward curve was gradually increasing while today, the curve is backwardated. This is a clear sign that the market sees a short-term dynamic that is disconnected from the medium-to-long-term fundamentals. The lasting impact of the COVID-19 pandemic remains to be seen. While many have opined that COVID-19 marks a turning point in energy transition, the IEA recently released a five-year forecast of oil demand that shows steady growth, albeit at rates that are below historical expectations. Gas markets are a paradox. At the Henry Hub and at LNG destinations, demand grows, investment lags and prices will occasionally attract attention. Traders, so far though, are unconvinced and futures prices don’t indicate imminent scarcity at any link in the value chain.

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EY Price Point: global oil and gas market outlook

We enter 2021 on a note of cautious optimism for global health, the world economy, and the oil and gas markets. The first weeks of December brought approval in the US and the UK of the first of several COVID-19 vaccines. The speed with which vaccine development occurred is unprecedented, but certainly welcome. In the weeks following the early November announcement of 90+% effectiveness by the manufacturer of the first approved vaccine, the price of WTI crude oil increased by US$10/bbl to US$48/bbl, the highest level since early March. Sustainability hasn’t returned yet, and whatever time it takes to get the world to normal, it will take even longer for normalization within the oil and gas markets. Inventories remain at historically high levels and, optimistically, it will take until April before inventory returns to levels observed in the preceding five years. That’s an estimate, and there has obviously been some difficulty properly calibrating the expectations of how balance will return and how long it will take. In late November, OPEC met to adjust its output plans because of the anemic rebound in demand. In mid-December, the IEA lowered its demand forecast for 2021 due mostly to continued sluggishness in aviation fuel demand. A mild winter has interrupted a recovery in North American natural gas prices after a run-up motivated by curtailed capital expenditures, upstream activity and production. After an initial meltdown, with cargo cancellations and dramatic price reversal, LNG markets have made a remarkable comeback, and the spread between Asia and Henry Hub has reached a level we haven’t seen in almost three years. It may be the case that interruption in FIDs has brought us to the cusp of a balance that can support reliable returns.

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EY Price Point: global oil and gas market outlook (Q4, October 2020)

Oil and gas prices have recovered steadily from their lows and are relatively stable, but that stability is supported by the combination of purposeful withholding of production by oil-producing countries and economic stress on upstream independents. Oil prices closed the quarter roughly where they started it, while refining spreads were down slightly. LNG spreads were substantially higher at the end of Q3 than they were at the beginning of the quarter but are still roughly half of what is generally thought of as sustainable. Going forward, the market will be looking closely at how the economy and demand respond to new developments with respect to a potential COVID-19 vaccine and the US election.

EY Price Point: global oil and gas market outlook

As we close the second quarter of 2020, in most of Europe and Asia, the first (and hopefully last) wave of the COVID-19 crisis appears to be abating. In the parts of the US where the virus hit early, the profile has largely matched Europe’s, while in other parts, the urge to reopen businesses has trumped the desire to contain the virus and uncertainty looms. In the developing world, the crisis has just begun, but without the economic headroom and resources necessary to contain it. As the crisis unfolded, the effect on oil and gas demand has been predictable but difficult to gauge precisely and therefore difficult to manage. Oil prices have crept up steadily as production has been curtailed through coordinated action (OPEC+) and because of economic reality (unconventional oil in North America). That trend has been subject to momentary spasms when bad news hit the market. It would be understandable if traders were nervous, and it seems that they are. Although nowhere near where it was at the peak of the crisis, option implied volatility is still at historically high levels. Gas markets, without the benefit of coordination on the supply side, continue to deal with the market implications of storage at or near capacity. Interfuel competition in power generation has always provided something of a floor, but those lows have been, and will continue to be, tested.

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1. Turning the tide on cancer drug costs The increase in the median monthly cost of cancer drugs in the US since 19902 ©2015EYGMLimited.AllRightsReserved.EYGno.FN0236.EDNone 1 A rising tide of new cancer drugs helps patients. These contracts are complex to build, but can provide a strong foundation for patient access. To hold back the tide of oncology drug costs, payers …3 ... experiment with new models US payers test indication-speciﬁc pricing, taking advantage of four new drug value tools. Since 2006, NICE has issued negative recommendations for of the cancer drugs reviewed.3 ... limit patient access Innovative risk-sharing agreements are another way to turn the tide.4 of the contracts are for cancer drugs.4 65%The number of risk-sharing contracts created in the UK and Italy since 2006 90 Sources: 1 U.S. Food & Drug Administration, Memorial Sloan Kettering Cancer Center, Decision Resources. 2 Peter Bach, Memorial Sloan Kettering Cancer Center, Center for Health Policy and Outcomes, "Price and Value of Cancer Drug," 2015. 3 EY, National Institute for Health and Care Excellence (NICE). 4 Van de Vooren, et al., “Market-access agreements for anti-cancer drugs,” J R Soc Med (108): 166–170, 2015. Since 1990, new cancer drugs have been approved in the US. 117 50Another could reach the market by 2020.1 $41% >700% 2 This wave of innovation could drown payers.

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