Background/Purpose:  Biological therapies have importantly contributed to controlling disease activity in patients with inflammatory rheumatic diseases. As the high costs of biologics are a threat to affordability and accessibility of these drugs for patients, attempts are made to decrease both the price and the quantity of the biological use. Examples of these attempts are start-/stopcriteria, dose reduction strategies and reduction of medication waste. Since recently, both intravenous- (infliximab) and subcutaneous (etanercept) biosimilars are available in Europe. Furthermore, pharmaceutical companies are altering their marketing strategies from a technology push/aggressive marketing targeted on individual doctors, to a new form of long term partnerships between hospitals as organizations and pharmaceutical companies. These partnerships should not only result in more attractive drug prices, but also to co-creation of innovations to improve decreased drug use, accessibility, affordability and the quality of healthcare. On top of that, long term partnerships prevent yearly time consuming price negotiations between hospitals and pharmaceutical companies. Aim: To create value-based long term partnerships between our hospital and pharmaceutical companies in order to improve both the quality and the cost-effectiveness of rheumatologic patient care.

Methods: First, an independent working group of rheumatologists and pharmacists employed at our hospital prepared a list of interchangeable biologics for new patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis. Then, nine pharmaceutical companies were invited to offer a proposition for partnership with our hospital. This proposition had to include a combination of a multi year attractive price proposition and a proposal for projects for optimization of biological drug use and/or improvement of rheumatology care. Separate meetings with the CEO, head of pharmacy and the medical managers of the rheumatology department of our hospital and representatives of the pharmaceutical companies were scheduled in order to discuss the propositions and find the common goals in the partnerships. All proposals were put in a model, in order to calculate long-term benefits/costs.

Results: 1936 patients in the Sint Maartenskliniek use biologics for their rheumatic disease. 21 rheumatologists of the Sint Maartenskliniek declared all tumor necrosis factor alpha inhibiting drugs (TNF-i), tocilizumab (RA only) and abatacept (RA only) interchangeable with respect to new patients with above mentioned diagnoses and declared the reference products of TNF-i infliximab (Remicade ®) and etanercept (Enbrel ®) interchangeable with their biosimilar counterparts for both new and current users. After separate sessions with individual pharmaceutical companies, three companies were selected and finally two were granted a first or second position of preference for a period of four years with a six month adjustment window of the price according to developments in the market. The model was used to calculate costs and benefits of each proposal. As a result of this process, a 25% reduction of the price of biologics was obtained (compared to last years price), as well as an increase in mutual investments in care projects such as e-health, medication adherence and care pathways.  

Conclusion: Creating long-term alliances between hospitals and pharmaceutical companies is an effective strategy to achieve substantial reduction of medication costs (price and quantity) and improvement of quality of care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvement-of-quality-and-cost-effectiveness-of-rheumatology-care-by-creating-long-term-alliances-with-pharmaceutical-companies/