Hepatitis C Virus | Access & Reimbursement | Detailed, Expanded Analysis (Brazil & Colombia)

Publish date: November 2016

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Introduction

Chronic Hepatitis C (HCV) affects several thousand people in Brazil and Colombia. New therapies allow cure in a short period of time with minimal side effects, in contrast to older options. Brazil updated the HCV clinical guidelines in 2015, and Colombia has recently started prioritizing this disease. Both countries are eager to adopt new technologies, but are also undergoing economic hardships. Likewise, Colombia’s plan of benefits will soon experience significant changes, and ongoing discussions may freeze the healthcare budget in Brazil. Hence, only drugs meeting payers’ and physicians’ clinical and economic expectations will succeed in this highly profitable, yet competitive, market. This Access and Reimbursement analysis provides key insights for navigating the chronic HCV therapy market in Brazil and Colombia, and for adapting a branded therapy’s value message to payers and physician needs and expectations in each country.​

Scope:

Decision Resources Group’s Access and Reimbursement module for the hepatitis C virus in Brazil and Colombia explores the prescribing patterns for current chronic HCV therapies, the potential impact of the anticipated arrival of novel therapies, and key national and regional market access factors that will shape the use of chronic HCV therapies over the next two to three years. This report draws on insights from 103 surveyed physicians and from interviews with six payers in Brazil and Colombia, all of whom have influence at the regional or national level.

Markets covered: Brazil and Colombia

Primary research:

  •  103 specialists:
    • 36 specialists in infectious diseases
    • 30 specialists in gastroenterology
    • 19 specialists in hepatology
    • 18 physicians from other specialties such as internal medicine
  • 6 payers:
    • Brazil:
      • Former member of CONITEC, responsible for receiving, analyzing, and assembling dossiers to support the plenary decision.
      • Health technical director in the Group of Pharmaceutical Support of the Coordinating Body of Science, Technology and Strategic Products of São Paulo’s State Health Secretary.
      • Technical analyst of social policies in the Health Ministry. Formerly at the Health Ministry’s Department of Pharmaceutical Care.
    • Colombia:
      • University professor in health economics and health management. Former president of the Board of Medical Devices Assessment of INVIMA (Colombia) and member of the board of ISPOR-Colombia.
      • Director of medical audit at SALUDVIDA EPS (Contributive and Subsidized Schemes).
      • Representative of Aliansalud EPS (Contributive Scheme and Pre-paid Medicine).

Questions Answered in This Report:

  • What is the public and private healthcare coverage for chronic HCV therapies in Brazil and Colombia? How do payers’ policies and infrastructure influence access to specialized healthcare and treatments?
  • What are the current drivers of and barriers to the prescribing of chronic HCV therapies? What are the main cost-related/clinical constraints to uptake?
  • What is surveyed physicians’ and payers’ expected pricing of emerging therapies for chronic HCV?
  • How do payers expect access to premium-priced therapies for chronic HCV to evolve in the next three years, and which emerging therapies do payers expect will be covered?
  • How do physicians expect to prescribe emerging agents for chronic HCV? What are these therapies’ likely impact on current brands over the next three years?
  • What clinical benefits do physicians and payers in Brazil and Colombia seek from emerging chronic HCV therapies? What types of savings on direct and indirect costs are payers looking for?
  • What roles will head-to-head and pharmacoeconomic outcomes play in differentiating the reimbursement of emerging chronic HCV therapies versus those currently available?

Table of contents

  • Detailed, Expanded Analysis (Brazil & Colombia)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New Hepatitis C Therapies in Brazil and Colombia
    • Successes and Stumbles
      • Successes Among Hepatitis C Therapies in Brazil and Colombia
      • Stumbles Among Hepatitis C Therapies in Brazil and Colombia
      • Brazil: Coverage Successes and Stumbles of DAAs
      • Colombia: Coverage Successes and Stumbles of DAAs
    • Key Stakeholders in the Road to Market Access
      • Brazil
      • Colombia
    • Key Market Access Roadblocks
      • Key Market Access Roadblocks for Hepatitis C Therapies in Brazil and Colombia
      • Brazil: Key Market Access Roadblocks
      • Colombia: Key Market Access Roadblocks
    • Reimbursement Dynamics
      • Brazil: Coverage Dynamics for Hepatitis C
        • Brazil: HTA Details and Implications in Drug Coverage
        • Brazil: Drivers of Formulary Coverage
        • Brazil: Coverage and HTA Details
        • Brazil: Lessons Learned and Key Takeaways
        • [#Country#: Reimbursement Background]
      • Colombia: Coverage Dynamics for Hepatitis C
        • Colombia: HTA Details and Implications in Drug Coverage
        • Colombia: Drivers of Formulary Coverage
        • Colombia: Coverage Details
        • Colombia: Lessons Learned and Key Takeaways
        • Colombia: Reimbursement Background
    • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
      • Prescriber Preferences for Genotype-1-Infected Patients
      • Prescriber Preferences for Genotype-2-Infected and Genotype-3-Infected Patients
      • Impact of Payer Policy on Prescribing for Chronic Hepatitis C
        • Impact of Payer Policy on Prescribing for Chronic Hepatitis C: Dynamics of Access
        • Impact of Payer Policy on Prescribing for Chronic Hepatitis C—Changes in Prescribing Without Access Barriers
      • Top Prescribing Drivers: Chronic Hepatitis C
      • Key Levers and Constraints on Current Therapies
    • Market Access Landscape for Emerging Therapies
      • Likely Impact of Emerging Therapies for Chronic Hepatitis C
      • Market Access Challenges for Emerging Therapies for Chronic Hepatitis C
      • Payer Opinion on Emerging Therapies for Chronic Hepatitis C
    • Methodology
      • Primary Research Design
      • Physician Demographics and Practice Setting
      • Pricing Methodology
    • Appendix
      • Commercial Context
        • Epidemiology: Total Prevalence of Hepatitis C in Brazil and Colombia
        • Treatment Guidelines for Hepatitis C in Brazil and Colombia
        • Key Drugs for Chronic Hepatitis C in Brazil and Colombia
        • Price per Day of Treatment with Drugs for Chronic Hepatitis C (Second-Generation DAAs)
        • Timeline of Approvals of Key Drugs for Chronic Hepatitis C
        • Emerging Therapies Profiles
      • Physician Survey Data

Author(s): Nuno Tiago Giao Antunes, PhD

Nuno T. Antunes, ,  is senior business insights analyst on the Infectious, Niche, and Rare Diseases team at Decision Resources Group, specializing in antibacterial agents. Previously, he was a Latin America Market Access senior analyst in the Global Market Access Insights Team, where he developed expertise in market access, pricing and reimbursement, health technology assessment, and health policy. Nuno holds a in animal health from the Universidad de las Palmas de Gran Canaria, Spain, and a degree from the Universidade de Trás-os-Montes e Alto Douro, Portugal. Prior to joining DRG, he conducted research in antimicrobial resistance and antimicrobial development, and worked in the medical devices industry as a scientist.