Is it time Market Access became greener?
Does healthcare get a free pass or are we missing opportunities to demonstrate differentiation?
When it comes to reimbursement and pricing decision-making, payers typically consider the clinical, economic, ethical, and social aspects of a health technology. Some payers or HTA bodies may also look at or request information on environmental safety (such as what risks may occur to the environment when using a new health technology). Still, few are considering a technology’s carbon footprint or environmental sustainability.
Should healthcare have an amnesty on environmental sustainability? Are we missing an opportunity to spur on a new wave of innovation in the healthcare sector and create new ways for companies and their products to demonstrate differentiation?
The good news is that there are growing discussions around incorporating environmental impact or sustainability into healthcare decision-making. And, lucky for you, I have an example that shows how it can be done!
So who’s the trailblazer?
It’s NICE! They have developed an asthma inhaler decision aid explaining the carbon footprint of different inhaler options for people who would like to reduce the environmental impact of their asthma treatment, providing an individual’s asthma can continue to be as well controlled as possible.
The decision aid outlines how different inhalers affect the environment by considering:
· Whether the inhaler contains propellant
· The type of propellant the inhaler contains
· The amount of propellant released per puff
“The Ventolin Evohaler brand of salbutamol contains more propellant (gas) per puff than other salbutamol metered dose inhalers. Flutiform and Symbicort metered dose inhalers contain a type of propellant that has a more powerful greenhouse effect than other metered dose inhalers that contain similar medicines. Dry powder inhalers do not contain propellant”
After outlining the carbon footprint of each type of inhaler, the decision aid emphasises that clinical outcomes are still more important– as controlled asthma ultimately leads to less inhaler use.
“The most important thing is to keep your asthma under the best control possible, using inhalers that suit you well. This will also help reduce the carbon footprint of your treatment. The aim is that you have no or minimal asthma symptoms, and you should not need to use your reliever (rescue) inhaler more than twice a week”
NICE is currently producing an evidence summary on desflurane – a general anaesthetic agent with a global warming potential 2,500 times greater than carbon dioxide.
Anaesthetic and analgesic practices account for 2% of the NHS’s carbon footprint so desflurane may be a good place to start if the NHS is to deliver on their goal of becoming the world's first carbon net zero national health system.
So while there are some emerging efforts to quantify the carbon footprint of medicines and use this information to inform treatment decision-making, we’re still in the early phases.
How can Pharma companies prepare?
Pharma should monitor further changes and new requirements in this space - as more environmental sustainability initiatives are implemented, Pharma will need to be prepared to collect and share more data, such as the carbon footprint of their medicines.
Where should Pharma start?
In therapy areas where there is limited clinical differentiation amongst treatment options: generics, biosimilars and “me-toos”. Since superior efficacy and safety will always hold the Trump card, the biggest opportunities to demonstrate added-value and differentiation will be the therapies area where clinical equivalence is assumed, and payers are looking for value beyond the product to aid their decision-making.
And when we talk about “payers” the focus need to be on those with procurement responsibilities where generics and biosimilars are concerned. This could be a chief pharmacist who sits on a P&T committee or a Ministry of Health committee responsible for determining tender criteria and specifications.
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Cover photo credit: Photo by John O'Nola on Unsplash