incrowd - 2019 healthcare predictions report · more states will expand medicaid n/a access to...

Diane Hayes, PhD, InCrowd President & Co-FounderMeghan Oates-Zalesky, InCrowd Senior Vice President of Marketing

February 5, 2019

InCrowd’s2019 Healthcare Predictions

Report

Survey Start Date End Date Days to Field Total Crowd Generalists Specialists

2019 Predictions Survey Dec 20, 2018 Dec 22, 2018 1 200 100 100

2018 Predictions Survey Nov 15, 2017 Nov 16, 2017 1 203 102 101

2017 Predictions Survey Dec 3, 2016 Dec 4, 2016 1 150 36 114

2016 Predictions Survey Nov 18, 2015 Nov 18, 2015 1 118 52 66

METHODOLOGY

Annual 5-minute MicroSurveys via InCrowd: Fielding Details

© 2019 INCROWD INC., ALL RIGHTS RESERVED

RESPONDENT DEMOGRAPHICS

2018 Predictions: (6 Questions), November 16, 2017, n=203Post-Tax Bill: (2 Questions), January 5-6, 2018, n=201

2019 Predicationsn = 200

2018 Predictionsn = 203



Physician Type

PCPs 50% 50% 76% 44%

Specialists 50% 50% 24% 56%

Treatment Setting

Academic Hospital 25% 21% 21% 10%

Community Hospital 19% 27% 22% 13%

Office-Based 56% 50% 54% 67%

Other 0% 2% 1% 4%

Experience

Age 44 y/o 44 y/o 51 y/o 49 y/o

Mean Years in Practice 13 Years 13 Years 22 Years 19 Years

Annual 5-minute MicroSurveys via InCrowd: Respondent Details


* Differences between 2019 and the previous year (2018) are statistically significant at the 95% confidence interval.

88%

41%35%

26%

11%

87%

62%

15%

26%

11%

59%

40%44%

29% 28%

65%

39% 39%35%

22%

Making therapies moreaffordable for patients

Improving wider accessto available therapies

Bringing innovativedrugs to market faster

Focusing research onnew therapies with

fewer side effects andimproved efficacy

Innovating on themanufacturing processat pharma companiesto improve efficiency

2019 2018 2017 2016

Making therapies more affordable for

patients

Improving wider access to available

therapies

Bringing innovative drugs to market

faster

Creating new therapies with

improved safety & efficacy

Optimizing the manufacturing

process to improve efficiency

n=200n=203 n=150 n=118

Perceived Importance of Industry Changes (1/3)

**

2019 Predictions Survey Q3

Rank the importance of the following items or changes in the pharmaceutical industry that you feel are most critical to best meet the demands of our changing society.

Relative Importance of Industry Goals Over the Last 4 Years(% respondents ranking change as highly important, with top two rankings combined.)

Affordability, followed by access, are the most critical healthcare goals in 2019, following suit with priority ranks from previous years.


Making therapies more affordable for

patients

Increasing access to available therapies

Bringing innovative drugs to market

faster

Creating new therapies w.

improved safety & efficacy

Optimizing the manufacturing

process


2019 Predictions Survey Q3 Rank the importance of the following items or changes in the pharmaceutical industry that you feel are most critical to best meet the demands of our changing

society.

71%

8%

15%

5%

3%

17%

34%

20%

22%

8%

7%

22%

23%

34%

16%

5%

21%

21%

28%

26%

1%

17%

22%

13%

48%

Ranking 1 Ranking 2 Ranking 3 Ranking 4 Ranking 5(1=Most Important) (5=Least Important)

Ranking Breakdown for 2019 Industry Goals (n=200)

Affordability is overwhelmingly ranked as most important by 71% of respondents. By comparison, speed and breadth of new drug development are ranked first by only 15% and 5% of respondents,

respectively.


71%

8%

15%

5%

3%

17%

34%

20%

22%

8%

7%

22%

23%

34%

16%

5%

21%

21%

28%

26%

1%

17%

22%

13%

48%

71%

8%

15%

5%

3%

7%

22%

23%

34%

16%

5%

21%

21%

28%

26%

1%

17%

22%

13%

48%

Making therapies more affordable for patients

“There are millions of patients in this country with chronic illness who cannot afford their necessary medications, which is a crime in the richest country in the world.”

– Specialist, NY, age 42

Increasing access to available therapies

"I think we have wonderful medicine that is not reflected in our health outcomes due to access. What is the point of developing more drugs when they can’t reach the people who need it?”


Bringing innovative drugs to market faster

“Bringing medications that are new and novel to the market will help treat medical conditions better, and competition will help bring prices down.”


Creating new therapies w. improved safety & efficacy

“Side effects increase the cost of treatment, and improved drug efficacy will help decrease the cost to patient overall.”

– PCP, CA, age 66

Optimizing the manufacturing process

“Decreased costs associated with commercializing a drug will lead to decreased prices.”– Specialist, NC, age 38



Rank the importance of the following items or changes in the pharmaceutical industry that you feel are most critical to best meet the demands of our changing society.

Verbatims Among Those Ranking Industry Goal Most Important

Respondents who rank other factors as more important than access and affordability often do so because they ultimately improve cost to patients, albeit in a more round-a-bout way.


2019 n=200 2018 n=203 2017 n=150

Federal gov. will find ways to defund the ACA N/A

Children up to age 26 will be allowed to stay on parents' insurance

Preexisting conditions coverage provision will remain in place

Insurance mandate will be eliminated N/A

ACA will remain in place, despite defunding efforts & recent Texas ruling N/A N/A

Mental health coverage will be allowed

Quality of healthcare will improve

More states will expand Medicaid N/A

Access to healthcare will improve

Costs of healthcare will improve

73%

71%

70%

69%

60%

58%

45%

44%

32%

20%

2019 Healthcare Predictions (1/2)


Tell us what you think is the likelihood of each of the following statements (Very Likely, Somewhat Likely, Somewhat Unlikely, Likely)

74%

69%

66%

66%

49%

41%

35%

27%

18%

85%

79%

57%

40%

31%

31%

Respondents Predicting Likelihood of Healthcare Change Over the Last Three Years

(% Respondents Finding Occurrence Very Likely or Likely)

* No statistically significant differences between 2019 and the previous year (2018) at the 95% confidence interval.

Only 32% of respondents predict that access will improve in 2019, with three of the top four predictions threatening to reduce the number of patients with health insurance in the US.


Federal gov. will find ways to defund the ACA

Children up to age 26 will be allowed to stay on parents' insurance

Preexisting conditions coverage provision will remain in place

Insurance mandate will be eliminated

ACA will remain in place, despite defunding efforts & recent Texas ruling

Mental health coverage will be allowed

Quality of healthcare will improve

More states will expand Medicaid

Access to healthcare will improve

Costs of healthcare will improve

2019 Healthcare Predictions (2/2)


Tell us what you think is the likelihood of each of the following statements (Very Likely, Somewhat Likely, Somewhat Unlikely, Likely)

Respondents Predicting Likelihood of Healthcare Change Over the Last Three Years

(% Respondents Finding Occurrence Very Likely or Likely; n=200)

22%

35%

30%

30%

15%

15%

9%

8%

4%

4%

51%

36%

39%

39%

45%

43%

36%

36%

28%

16%

23%

20%

23%

21%

29%

29%

38%

36%

45%

36%

4%

10%

9%

10%

11%

14%

17%

20%

24%

46%

Very Likely Somewhat Likely Somewhat Unlikely Very Unlikely

Respondents are cynical about healthcare costs, with 82% finding them unlikely to improve in 2019.


Hopes for 2019 Compared to Previous Years (1/2)

ResponseOpen Ended

2019n=200

2018n=203

2017n=150

2016n=118

$ Reduced drug costs ↑ 64% ↓ 62% ↑ 70% 40%

$ Improved insurance coverage / less prior-authorizations ↓ 12% ↑ 15% ↓ 7% 11%

Less DTC marketing and sales reps 9% ↑ 9% ↑ 7% 4%

$ Price transparency & formulary access for doctors ↑ 9% ↑ 4% ↓ 1% 4%

$ More generics ↑ 7% ↑ 5% ↓ 4% 8%

Novel drug discovery and new formulations ↓ 5% 8% ↑ 8% 4%

$ Legislative price regulations (i.e. Caps) ↓ 3% 11% ↓ 11% 12%

Opioid control initiatives ↓ 1% ↑ 2% ↓ 0% 1%

$ Lower copays 1% 1% ↓ 1% 3%

Decreased pharma lobbying ↓ 0% ↑ 2% 1% 1%

Better FDA support for orphan drugs ↓ 0% 1% ↑ 1% 0%

2019 Predictions Survey Q1a What important changes would you most like to see in the pharmaceutical industry in 2019?


95% of respondents cite efforts to improve costs as changes they’d like to see in 2019, including improving insurance coverage (12%), price transparency (9%), generic availability (7%), regulations

(3%), and copays (1%).


Industry should help improve patient access Payors should help improve patient access

“Companies need to stop increasing prices for lifesaving devices like the EpiPen that have not actually changed in their technology for many years.”

- PCP, IN, age 33

“Price gouging is an embarrassment for the industry. Americans should not pay more than foreigners for the same drugs.”

- PCP, MA, age 62

“Pharma needs to focus less on direct-to-consumer advertising and finally recognize that the exorbitant pricing of medications (including price hikes on long-established generic medications) is contributing to healthcare compromise from many people.”

- Specialist, FL, age 62

“Insurance companies need to institute more common sense prior authorization requirements. Inexpensive generics should never require a PA.”

- PCP, MA, age 62

“Payors need to provide an easily accessible list of meds that are covered for patients so we don't have to just "guess" what statin (for example) might be covered”

- PCP, MA, age 46

“Transparent pricing of medication with a clear cut pricing sheet for every insurance and cash pay should be made available. Also, there should be a universal tool for insurance verification to tell the patient exactly how much they should be paying.”

-Specialist, IL, age 34

Hopes for 2019 Compared to Previous Years (2/2)

2019 Predictions Survey Q1a What important changes would you most like to see in the pharmaceutical industry in 2019?

Respondents are split on whether payors or companies should drive efforts to improve costs in 2019.

While price gouging is at the fault of industry, insurance companies fail to take important measures that

could help physicians become more cost conscious.


Predictions for 2019 Compared to Previous Years (1/2)

ResponseOpen Ended

2019n=200

2018n=203

2017n=150

2016n=118

No change (same as previous years) ↓ 60% ↓ 65% ↑ 74% 42%

D Rising drug prices ↓ 20% ↑ 24% ↓ 23% 24%

New approvals (mostly me-too drugs) ↑ 8% ↑ 6% ↑ 5% 4%

C Lowering drug prices ↑ 6% ↑ 2% ↑ 1% 0%

More DTC advertising & sales reps ↓ 5% ↑ 8% ↑ 5% 4%

More generics & biosimilar development ↑ 4% 1% ↓ 1% 2%

More price transparency ↑ 3% ↑ 2% ↓ 1% 2%

D Worsening insurance coverage ↓ 2% ↑ 6% ↓ 2% 6%

C Better insurance coverage ↑ 2% 0% ↓ 0% 1%

Increased government regulations ↓ 2% ↑ 3% ↓ 1% 4%

D More drug shortages ↑ 1% ↓ 0% 1% 1%

C Better patient or copay assistance programs ↓ 1% ↑ 3% ↑ 0% 0%

More M&A consolidations 1% ↑ 1% ↓ 1% 7%

Less government regulations ↑ 1% ↓ 0% ↓ 2% 0%

2019 Predictions Survey

Q1b What changes do you realistically predict we will see in the pharmaceutical industry in 2019?


KEY

C Unanimously

positive sentiment

D Unanimously

negative sentiment

A majority predict 2019 won’t differ from previous years (60%), however a notable proportion predict rising drug

prices (20%) and new drugs (8%), albeit not necessarily ones that offer improvements to those already on market.


Among the majority predicting that no changes would be brought about in 2019, respondents are divided on who is responsible for industry inertia. While some find that industry practices are driven by

greed, others note that industry has no reason to change without incentivization.

2019 Predictions Survey Q1b What changes do you realistically predict we will see in the pharmaceutical industry in 2019?

Industry is responsible for bringing about positive change

Government is responsible for bringing about positive change

“Big pharmaceutical companies have a lot of money and very powerful lobbyists, so nothing will change.”

- Specialist, NJ, age 33

“I do not expect to see any changes. They will continue to produce new excessively overpriced medications and fail to recognize the inability of people to afford necessary medications.”

- Specialist, FL, age 62

“I don’t think that there is a lot of incentive for pharma to change right now.”

- Specialist, PA, age 45

“Nothing will change at all, its too political of a situation and no action will be done to assist patients or doctors.”

- Specialist, IL, age 34

“Given that a judge just struck down ACA and new laws are unlikely to be brought out in our divided Congress, if I was a drug company I would be reticent to do much new in this ever changing landscape. And I don’t blame them.”

- Specialist, WA, age 56

Predictions for 2019 Compared to Previous Years (2/2)


What industry can do

Potential Initiatives for Reducing Costs

ResponseOpen Ended

2019n=200

2018n=203

Spend less money on DTC marketing & advertising

↓ 52% 55%

Increasing generics & biosimilars by shortening patents

21% 21%

Stop maximizing profits with irrational price increases & unnecessarily reformulations

↑ 13% 10%

Reduce executive salaries & bonuses 13% 13%

Greater support for financial assistance programs (inc. vouchers)

↓ 7% 12%

More collaboration between companies and with government and academia

↓ 3% 4%

Optimize processes involved in R&D and manufacturing

↑ 3% 1%

Follow international healthcare models and distribute costs evenly amongst countries

↓ 2% 4%

ResponseOpen Ended

2019n=200

2018n=203

Informing themselves of costs & adapting cost saving prescription practices

↓ 39% 43%

Prescribe generics whenever possible ↑ 38% 36%

limit use of expensive tests & scans ↓ 14% 18%

Advocate & lobby for policy change 6% 6%

Focus on preventative medicine 3% 3%

Appropriate use of inpatient, ER, & urgent care

↑ 2% 0%

Enroll more patients in clinical trials ↑ 1% 0%

Eliminate administrative costs 1% 1%

What physicians can do

2019 Predictions Survey Q2 What suggestions do you have for the pharma industry to help reduce drug prices? What actions can physicians take to help reduce healthcare costs?

Respondents find that industry can reduce costs by spending less on DTC advertising (52%), followed by shortening or curtailing efforts to extend patent life (21%).

Physicians can help by “prescribing smart” i.e., staying informed on drug pricing (39%) and limiting use of non-generics (38%) and expensive tests (14%) when possible.



Respondents were divided on their response to ACA developments in 2018. While 17% were surprised by the Texas ruling, 12% are surprised that the ACA still manages to maintain ongoing support.

Response, 2018 SurveyOpen Ended

%n=203

The ACA has not been repealed and healthcare change has not been enacted

56%

Rising drug and insurance costs 7%

Medicaid/ Medicare expansion and privatization

5%

Loss of access to contraception and woman's health 1%

Reflections on 2018

What surprised you about 2018?

2019 Predictions Survey Q5 What is one thing that surprised you in 2018, or that you found to be unexpected given the circumstances?

Response, 2019 SurveyOpen Ended

%n=203

Ruling that the ACA was unconstitutional, with no proposed substitute 17%

ACA is still around and has continued support 12%

Rising drug and insurance costs despite Trump promising regulation 8%

Mylan EpiPen shortage and cost of insulin 3%

Loss of access to contraception and woman's health 3%

Medicaid still active 2%

Lower price of some drugs 2%

Improved reimbursement for physicians 2%

What surprised you about 2017?


Diane Hayes, PhD, InCrowd President & Co-FounderMeghan Oates-Zalesky, InCrowd Senior Vice President of Marketing

For questions, please [email protected].

mailto:[email protected]

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