This month we include insight from Sheri Sellmeyer about the US bill aiming to lower drug prices and we’ve summarised the drug reviews that have been conducted in the UK, France and Germany over the past month. If you have any questions regarding the information below please contact Cath at cbacon@fingerpostconsulting.com.

PLEASE NOTE: All information reported in the blog represents the views of FINGERPOST and/or the individuals credited and do not reflect the views or opinions of other organisations that may be mentioned in context.

USA: U.S. bill that would lower drug prices heads to House vote
The current impeachment inquiry into President Donald Trump has overshadowed a huge event in the world of drug pricing and reimbursement – a proposed bill to lower drug costs in the United States.

The bill would allow the government to negotiate lower prices for at least 35 high-cost drugs each year, provided the drugs do not have at least two generic competitors. The prices would apply to both Medicare (covering seniors) and those who are privately insured – more than 280 million people.

This would be a sea change for the United States. Unlike other countries, the U.S. does not regulate the prices of new prescription drugs, and it allows every drug proven safe to come into the market, regardless of whether the benefit is determined to justify the cost.

The bill is considered likely to be passed by the Democratic-majority House, but faces stiff opposition in the Republican-controlled Senate. The drug industry argues that lowering drug prices would lower profits, which would make the industry less attractive to investors and result in less research for new cures. A recent blog post on PhRMA, the leading biopharmaceutical trade group, argues that the drug pricing plan would hurt the development of treatments for Alzheimer’s, which affects 5.4 million Americans, predicted to grow to 14 million by 2050.

Lowering the cost of prescription drugs was a major tenet of President Trump’s campaign platform, but he has yet to gain any traction on his own proposals. A plan to require drug companies to disclose their prices in television ads was struck down by a federal judge. His blueprint for lowering drug costs published in spring 2018 lists a number of proposals, including “take steps to end the gaming of regulatory and patent processes by drug makers to unfairly protect monopolies.” He has frequently complained that other countries use socialized healthcare to command unfairly low prices from U.S. drug makers, putting the burden of financing drug development on Americans.

The Congressional Budget Office estimated the bill would save Medicare $345 billion over seven years. About a fourth of Americans say they have difficulty paying for their drugs – a percentage that goes to 33% for those with low incomes, 38% for those taking four or more prescription drugs, and 43% for those in fair or poor health, according to the Kaiser Family Foundation, a nonprofit, nonpartisan organization that focuses on healthcare issues.

Prescription drugs in the U.S. cost on average more than 50% than in other developed markets, according to analysis by information and analytics company IHS Markit. Prices for cardiovascular, musculoskeletal and nervous system drugs average about 80% lower in other developed countries. For example, according to the Kaiser Family Foundation, the average price of the blood-thinner drug Xarelto is more than double that in the United Kingdom.
 
The House bill could reach the floor for debate next week. In the meantime, House Democrats are debating the bill among themselves, with some arguing the proposed law doesn’t go far enough to negotiate prices and others concerned about crafting a bill that’s palatable to the Senate.

Thanks to Sheri Sellmeyer for submitting this article. To find out more about Sheri, you can access her Linked In profile via our Global Associates tab.
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Health technology appraisal published during October: UK,  France, Germany
See the slideshow below for the HTA summary tables. Get in touch if you have any questions or would like to see HTA outcomes for other markets in future Global Round-ups.

At Fingerpost we support and deliver projects via a specialized network of freelancers operating within market access and related fields. We assess the needs for each project and compile a team of independent specialists to deliver that project to its highest potential.  We understand the value that  flexibility brings, and find that this allows us all to work smartly and effectively when it counts. Of course, this way of working leads to some very busy weeks but it also means that we absolutely, without quibble take that time back in lieu: have some extra hours with the children or squeeze in an extra yoga session on a quieter week.

As Fingerpost grows and we continue to evaluate and refine our offering, we have been engaging with more and more freelancers across the globe. However, the increased volume of freelancers on our database has also highlighted a number of inconsistencies and differences between individuals in market access and related fields.  Some of these differences can be attributed to cultural practice (how individuals like to work, communication styles etc), whereas others relate to the practical elements of billing for work (rates, how many hours count as ‘a day’ etc). After noticing some of the differences, Cath and I both agreed it would be useful to conduct a survey that would help us identify some of the trends amongst freelancers in market access (and related fields e.g. HEOR, pricing, medical communications). The insight from the survey will hopefully help us to understand best we can support our freelance team and represent them fairly with the clients we work with.

So, in May, we developed an anonymous, 10-question survey to capture data that would address the following research questions:

•       What are the minimum requirements to become a freelancer?
•       What fees are people charging and what influences this?
•       How are freelancers contracting within market access and related fields?
•       Why do people leave permanent roles to take up a freelance position within Market          Access and related fields?
•       What aspect of freelancing could be improved?

A small (n=39) but representative sample completed our survey over the 7 weeks we ran it for. Participation was completely voluntary and anonymous, which relieved any burden associated with processing personal data.

We have now analysed the data and summarized the outcomes into a concise presentation report. Although the outcomes are primarily targeted at informing ourselves and other freelancers within the sector, we’re also aware that the findings may appeal to those currently, or considering, working with freelancers. Here’s a quick taster of some of the key findings from the survey:

·       There are no obvious minimum requirements/expectations with respect to level of degree or number of years in a permanent role, prior to becoming a freelancer.
·       The average hourly rate was slightly higher for those with a PhD (vs MSc, BSc and job experience), but there was no trend to suggest that a higher level of degree qualifies a freelancer to charge more. However, those with a BSc were less inclined to contract with Academia or Medical Communications agencies than those with a MSc or PhD.
·       Higher hourly rates were associated with more years of work experience, as well as pricing, outcomes research and strategic market access/HEOR services.
·       Industry and public sector appear to accept higher hourly rates than consultancies and agencies.
·       More freelancers actively pursue business with new clients than those who do not, but the frequency of contact is most likely down to personal preference.
·       Flexibility and quality of life were the main reasons people choose to move into a freelance position, and flexibility and variation of roles are deemed to be the most enjoyable aspects of freelancing. However, uncertainty (financial/workstream) and lack of interaction were reportedly the least enjoyable aspects.

The survey also allowed us to analyse the average hourly fee charged based on years of experience, type of contracting organization and area of expertise. There were some very interesting findings from this perspective but you’ll have to read the report to find out more!
If you would like a copy of the report, please drop me (cbacon@fingerpostconsulting.com) or Victoria (vwooldridge@fingerpostconsulting.com) an email. Anyone is welcome to peruse the findings; just state why you are interested in the email and we’ll pop a copy over to you.
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From our perspective the results have been very interesting and, although some of the findings only confirmed what we already suspected, there have also been some other key findings that we weren’t expecting. Overall, the survey has prompted us to change some of the ways we engage with freelancers. Ultimately, we hope this will make our project operation experience better for both the client and the freelancer, resulting in greater transparency and efficiency.

​In post as Director of Operations and External Resource at Fingerpost my role is quite self-explanatory; I manage our internal operations and I resource all the projects that we win with clients.  In this month’s blog it’s the external resource part that I’m keen to talk more about.

I’d been in recruitment for nearly 12 years prior to joining Cath at Fingerpost – the first 6 years solely within temporary market, where hourly/daily rates and large networks of ‘freelance’ candidates were my norm and the latter 6 years predominantly centric to permanent recruitment.  I loved the temporary side of recruitment but the markets I worked in didn’t win my interest - this was truly piqued when I went into Market Access and permanent resourcing.   The opportunity to join Cath and take responsibility for pulling together and managing project teams for her outsourced offering presented me with a chance to take two areas of interest (and a wealth of opportunity to learn new things) and blend them into what has been a wonderful role so far!

I’m a MASSIVE advocate of freelancers.  If, as a business, you are under resourced or under skilled and there is time pressure on you to deliver then why would you not invest in someone experienced who is willing to come into an unknown culture and team and leave again once the job is done? (They may even provide you with some great insights on methodology or practise whilst they’re at it!)  I’m pretty sure all the hiring managers/team leads reading this now are thinking ‘cost’ as one of the barriers, but I have experienced many a situation where the simple “pay as you go” cost of the freelancer is far less than the cost of not getting the job done on time or having to pull people off other projects to deliver yours.

Asides ‘cost’ another area for concern could be 'risk’.  Of course, the great thing about a freelancer is that there is no employment risk to your business but granted, this ‘risk’ element manifests itself in skill and ability to do the job well – and I will give you this one!  It’s always nerve-wracking as a recruiter, indeed as a manager, when you place a contractor who may not turn out to be as good as you thought; even with marvellous references, things can go wrong.  This is where the Fingerpost model works incredibly well.  We build a freelance project team where we are involved and can guarantee the outcome.  More often than not Cath works on content, provides quality control or strategic advice. Occasionally when we face extreme time pressures and see there may be a burden on one freelancer, we manage multiple freelancers working in unison to get the work completed quickly.  We have worked with many of our freelancers before and continue to build the network on positive recommendations.

Not only am I a massive advocate of freelancers but it seems so is the general workforce.  According to a 2018 report from the Office of National Statistics (UK) “The number of self-employed increased from 3.3 million people (12.0% of the labour force) in 2001 to 4.8 million (15.1% of the labour force) in 2017”.  As we frequently get enquiries about “becoming a freelancer” in the Market Access space, we have decided to conduct a short survey on freelancer experience to understand more about the role of a freelancer; measuring how freelancers are currently operating within market access and related fields e.g. medical communications, brand strategy, healthcare market research, HEOR, etc’ (you can participate here: https://www.surveymonkey.com/r/XK8BVXJ).  These results will be analysed in June and communicated in our July newsletter, although to give you a little snippet thus far, the overriding reasons for individuals taking the leap into the world of freelance are: lack of flexibility in permanent roles and negative company culture/politics in previous work places.
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Freelancing isn’t for everyone (and we have asked about the negatives in our survey too!), nor is it necessary or practical for businesses to engage with freelancers continuously. However, given the limited pool of candidates within Market Access/HEOR, we hope our survey results will prove valuable to both freelancers and employers alike – indeed, freelancers may even help us all to understand the best approach for attracting and retaining high-calibre individuals within the industry.

Victoria Wooldridge

Hello everyone, its Vic here!  What is to follow is my first Blog entry for Fingerpost – I could fill the piece with how I’m getting on after what has now been nearly three months in my new job but that has been done before (in short, I’m having a fab time!). 
Instead, I thought I’d share a snapshot as to the last couple of weeks at Fingerpost and what Cath affectionately refers to as our “quieter time” (!!)   
Many in Market Access Consulting will know that there are ‘project cycles’ and my first 10 weeks in this job was a real baptism of fire as we rode a huge crest of project deliverables.  In short, the wider team here planned, recruited for, conducted, analysed and reported on nearly 50 EU and US Payer Interviews.  In addition, we compiled desk research, proposals and analogue studies as well as designing and conducting three workshops – oh, and Cath did some Strategic Advice work both in the UK and France.  It’s been a busy whirlwind! 
We closed off a lot of this work in mid-March and proceeded to sit down, breathe (with tea and cake), tie up administration, work on some of our own company strategy/materials and think ahead to the pipeline of projects we have kicking off in the next few weeks… 
…well, we have had the opportunity to have some shorter, more relaxed days in lieu, (and a good volume of cake!) however, these weeks have been far from ‘quiet’ as more consultancies, including some new businesses, engaged with us for support including; 

• A request for proposal – Payer interviews 
• Requests for freelance support 
• Enquiries about permanent resource landscaping 
• Requests for training 

• A request for data extraction 

We also spent a day in London meeting with a new client and have organised another trip next week! 
With all this activity going on in our 'quieter time', I have returned to what I know best and have started scouring the landscape with the intention of growing our internal team as well as continuing to expand our freelance network.  We have added a ‘Join Us’ tab to the website and will continue to update this space with live vacancies.  Freelancers can also register their interest to work with us on this page. 
As a business our internal recruitment aim is to provide permanent staff with the flexibility of a freelancer alongside the safety cushion of employment – it’s a busy market and our quieter times aren’t strictly ‘quiet’ but we do value this time to recharge, take back some time, re-focus and mix things up with immersing ourselves in the tasks and learnings that come naturally in a small business.  
I’d love to keep in touch with anyone in Market Access who might be interested in a permanent role that offers a bit more flexibility or even those who are thinking of going down the freelance route and would like some friendly support and advice! ​