Marco Giacomelli, head of Generali Global Health (GGH), was a panel member at Roche Global Access Forum in Vienna last year. The panel discussed how partnering with the medical insurance industry can help the pharmaceutical giant extend access to costly medicines and diagnostic tests. Jamie Marshall, chief technical officer at GGH, delves further into this subject and outlines some of the work GGH has been doing outside of its traditional role of an international health insurance provider.
Healthcare providers around the world must balance cost and benefit when it comes to making certain treatments and medicines available to patients. Affordability can often be a barrier to accessibility, especially when a drug is new or has been developed to treat an uncommon condition.
To reduce access barriers, pharmaceutical giant Roche has implemented a programme of strategic partnerships around the world. In the UK, for example, Roche has partnered with the NHS to enable a pioneering and life extending drug to now be available at a reduced cost.
The drug in question, Kadcyla, prolongs the life of women with a specific form of terminal breast cancer by up to six months.
By reducing the full cost of Kadcyla from £90,000 per quality adjusted life to around £50,000 the NHS has been able to begin using the drug, making a difference for up to 1,200 women a year.
The benefit to Roche is that the drug has now been approved by the regulatory body, the National Institute for Health and Clinical Excellence (NICE), as it has now passed a cost-effectiveness test.
For every good news story, however, there are many instances of affordability preventing drugs from being readily available.
Collaboration with medical insurers
Collaboration between drug companies like Roche and medical insurance providers are one way to help solve this issue.
These partnerships create opportunities that deliver a favourable and sustainable private funding source for specialised care globally.
To date Roche has partnered with insurance companies in selected markets, including Europe, Asia and sub-Saharan Africa, to support the development of health insurance products for specialised oncology care.
And, through partnerships with re-insurers, Roche has enabled the launch of several private health insurance products (primarily critical illness/cancer plans with special focus on breast cancer) in China, India, Portugal, Hong Kong and Thailand.
In 2016, Roche began exploring options to expand the private health insurance initiative beyond cancer funding to molecular diagnostic services offered by Foundation Medicine focused on cancer.
These initiatives, and more, point to the fact that partnerships with private health insurance companies are starting to become increasingly important for drug companies looking to make their products available to the wider global community.
Above: Jamie Marshall, chief technical officer at GGH,
Medical insurers forging healthcare partnerships
For insurers, partnerships with drug companies are proving valuable in the race to differentiate themselves in a competitive market and to provide a wider range of specialist services to members than was previously possible.
To this end, partnerships with the wider healthcare community are also of interest to the medical insurance sector.
Genome testing, for example, recently hit the headlines when England’s chief medical officer Prof Dame Sally Davies said that the NHS must deliver “her genomic dream within five years” and that cancer patients should be routinely offered DNA tests to help select the best treatment.
Earlier in 2017, Generali Global Health partnered with Genesort to provide the option of genomic profiling for members diagnosed with cancer.
An innovative swab-test identifies which course of treatment is most suitable based on analysis of the member’s genetic profile. This means the member and their medical practitioner can have greater confidence in their chosen treatment plan, based on what treatments are known to work best with their genetic profile, globally.
A recent article published by Life Insurance International raised the question of confidentiality and genetic testing. This particularly applies to the life industry where full disclosure is still the norm when applying for this type of insurance.
Generali Global Health makes a test available to patients who have already been diagnosed with cancer, negating the concern over the life insurance issue to a degree.
That said, the life industry will need to review their current stance on full disclosure and how they use this data, to allow genomic testing to become a mainstream diagnostic test.
The value exchange of a member’s genetic profile for potentially lifesaving targeted treatment is clearly positive, but issues like data security, legislation and carefully controlled use of such data need to be future proofed as far as possible.
Evolution of medical insurance
There’s no doubt that these are exciting times for private medical insurers, especially international providers.
Many in the industry are moving away from the role of “claims payers” to health and wellbeing partners that actively work with members to support their long-term health standards.
This principle of being a health promoter and not simply a sickness insurer also has tangible and direct financial repercussions: managing a healthy population is more financially viable and socially responsible than to simply pay for a sick one.
It’s for reasons such as this that working in partnership with companies like Roche to create flexible plans is so important. This, as well as offering bespoke and innovative treatment from centres of excellence globally, is the future for companies like Generali Global Health and more importantly for our members seeking state of the art healthcare wherever they are in the world.