Is pharma missing key opportunities in private healthcare?

“No decision about me, without me!”

Unless you’ve been living on Mars in recent years, you’ll be well aware that the NHS mantra is supposed to demonstrate its commitment to giving patients much more say over their care and treatment. Of course, this doesn’t only apply to involvement in decision-making about medications, interventions and procedures, but also to the choice of provider who delivers the care and the setting in which it is delivered. 

As the emphasis on patient choice grows, there is increased recognition that at different stages in their overall care, patients are entitled to choose freely between NHS and private treatment; whether provided as a private service by an NHS body or by the independent sector.

 As a result, we are now seeing an increased demand to mix elements of privately and publicly-funded care for a single course of treatment.  It seems that patients are selecting private provision in specific circumstances; because they believe the NHS does not or cannot provide a clinically indicated aspect of the treatment due to concerns about its relative cost-effectiveness.

Alongside this growing trend in mixing private and publicly-funded care, there has also been double-digit growth in the self-pay element of the private healthcare market. Patients are increasingly choosing to self-fund their treatment and pay out of their own pocket. This trend is set to continue. For example, according to “The Private Healthcare UK Self-Pay Market Study 2015” from Intuition Communication, publishers of Private Healthcare UK, the London self-pay market is estimated to be growing at 20% annually.

Growth in self-pay treatment has been seen especially in cardiology, interventional radiology, dermatology and gastroenterology and there has also been a marked rise in the number of oncology patients.

The rising cost of private medical insurance premiums is one of the reasons behind the growth in self-pay (and as a result, there has been some decline in patient numbers in another part of the private healthcare sector); however, there are also many other factors behind the growth. Consequently, the private healthcare market is growing exponentially with annual growth of 5% forecast between now and 2016 – and strong growth in the sector is also promised for years to come.

One of the primary reasons for the greater interest in self-paying, via the private route, is the perception that private patients have less restricted treatment options in comparison to the NHS. The belief being that they can access treatments that are either no longer available on the NHS or treatments which have failed to secure NHS funding due to NICE restrictions. Indeed, many private providers openly promote the availability of the latest advances in medical technology that are not available through the NHS.   

Another perceived key benefit is that consultations usually take place more quickly privately compared to long NHS waiting lists. 

In short, some people are increasingly taking healthcare into their own hands because cuts mean they don’t qualify for treatment and others would rather pay than wait.  

Therapy areas not traditionally associated with “going private”

It is also interesting that in recent years many private medical insurers have extended their scope. Many now cover a vast range of conditions (albeit under certain circumstances) including ones that wouldn’t traditionally be associated with private medical insurance e.g. diabetes, respiratory conditions and multiple sclerosis.

Plus in recent years many private insurers have started to embrace oncology. Certain Bupa membership policies for example provide access to proven eligible cancer drugs and treatments and new drugs (following specialist recommendation) – as long as it has been licensed by the European Medicines Agency for the condition and is included on their list of advanced therapies and specialist drugs. Exceptions are made in some circumstances when a treatment is part of a clinical trial, following review and approval by Bupa.

With a number of drugs being delisted from the Cancer Drugs Fund in March 2015 and difficulties obtaining access to cancer treatments following stringent NICE approval,  there is a widespread and growing perception that only private healthcare offers patients a way through to access treatments that are not readily available via the NHS.

Pharma therefore needs to be investigating the following…

For many in pharma, the private market is often an afterthought. But with trends like these, perhaps the time is right to truly get to grips with this market opportunity?

After all, this sector could be fertile ground for usage of your product pre-NICE, not to mention those who have experienced the rigours of NICE negative rulings and now need to explore other avenues such as the private sector to secure access for your product.

Whatever the scenario, Adelphi’s experience indicates that the private market is a very different “kettle of fish” from the public sector. For those marketeers who want to ensure real success in private healthcare, we suggest you need to start by conducting comprehensive market research which will deliver an in-depth understanding of how the market operates.

There are numerous considerations which make it a very different world from the NHS. Below is just a taster of the sorts of topics which typically need to be explored….. 

• Who is the self-pay patient? What do they actually look like?
• What is the decision-making process for the use of new medicines in private healthcare?
• Is there a formulary or not?  If so, at what level?
• What degree of clinical autonomy do HCPs have compared to the NHS?
• How easy is it to access physicians who work in the private setting?
• How likely are physicians to use a new product in the private sector?
• What is the relationship between the private provider and the private insurer?
• How does this relationship impact on medicines usage/authorisation for usage?
• Do private insurers actually input into medical decisions?
• What is the role of the pharmacist?   
• How interventional is the pharmacist in prescribing decisions for private patients?
• Are private healthcare insurers and providers willing to interact/negotiate with pharma?

This article was written by Adelphi’s NHS Leads Judy Norcross, Research Director and Claire Nelson, Associate Director.

For more information on NHS and Market Access Research contact aruk@adelphigroup.com