Gene therapy’s biggest prize thus far in terms of market potential may be in the diabetes space, specifically diabetic complications, which are varied and afflict millions of diabetics. Several gene therapies targeting diabetic complications are in late-stage clinical development, including Engensis and RGX-314. These two gene therapies are projected to possibly receive U.S. marketing authorization in the second and fourth quarters of 2024, respectively.

As a treatment indicated for diabetic peripheral neuropathy, Engensis has a possible eligible population in the U.S. of 5.5 to 11.5 million adult patients. Meanwhile, as a treatment targeting diabetic retinopathy, RGX-314 has a potential eligible population of approximately 4.2 million adult patients.

If approved, these gene therapies could address deficiencies in care for these patients. Of course, not all eligible patients will be prescribed these treatments. Nevertheless, given the unmet need in this space, it’s projected that millions of patients would at least consider such therapies.

Diabetic peripheral neuropathy affects the feet and legs of patients first, followed by the hands and arms. Signs and symptoms include numbness or reduced ability to feel pain or temperature changes. Besides managing blood sugar to treat diabetic neuropathy, there’s a plethora of symptomatic relief medications which include nerve pain medications, anti-depressants, and anti-seizure medicines.

As an investigational non-viral gene therapy – to be taken at intervals, so not a one-time treatment - Engensis has the potential to become the first analgesic drug to significantly ameliorate and possibly reverse the progression of diabetic peripheral neuropathy. It holds great promise, but for payers the cost burden may be very difficult to manage.

Diabetic retinopathy is a leading cause of visual impairment. It is characterized by vascular lesions and neuronal damage of the retina. Treatment options for this condition are currently limited. Gene therapy has the potential to provide an alternative treatment for diabetic retinopathy with distinct advantages, such as longer therapeutic effect, less injection frequency, ability to intervene at disease onset, and potentially fewer side effects. RGX-314 is one such therapy –  an investigational recombinant adeno-associated virus vector – being developed as a potential one-time treatment for diabetic retinopathy and wet age-related macular degeneration. Similar to Engensis, the up-front costs for payers seeking access to RGX-314 may be very burdensome. Invariably the question is how, once these gene therapies gain regulatory approval, the healthcare system will be able to pay for these high-priced therapies that target such potentially large populations. Value-based pricing agreements, in which refunds would be offered in instances of treatments not attaining certain pre-determined outcomes, have proven to be highly effective.

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The Lyfegen Platform enables more efficient and transparent management of value-based drug pricing contracts for all kinds of cell and gene therapies – including those targeting large populations – by using intelligent data-driven algorithms to capture and analyze patient-level drug cost data. The Lyfegen Model & Agreements Library can help stakeholders explore real-world models and identify which model are best-suited for the specific use-case and desired negotiation outcomes.

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Learn more on: lyfegen.com

Roughly half a century ago, scientists first began hypothesizing that they could cure diseases by altering genes. Thanks to recent advances in the fields of molecular biology and gene editing, this hope of yesteryear has become a reality. Today, a growing number of cell and gene therapy products are being used to improve the health of patients around the world by fighting disease at the cellular level.

Most cell and gene therapy products are intended as one-time injection treatments, which in turn may offer durable cures. Until now, the overall costs - or budgetary impact to payers - of approved cell and gene therapies have mostly been manageable due to the (very) small populations being served. But this is about to change with the advent of treatments indicated for much larger populations and for much more common conditions such assickle cell disease, diabetic complications, and osteoarthritis.

However, without a feasible way for payers to pay for these treatments, patient access will remain a major impediment. In turn, this could ultimately result in a continued high societal burden for patients afflicted by diseases targeted by cell and gene therapies.

While upfront costs of cell and gene therapies can be very high on a per-unit basis, having a cure rather than a temporary and incomplete remedy or merely an alleviation of symptoms could lead to cost savings in the long run. And it’s been shown that certain cell and gene therapies may even be cost-effective in the short term, relatively soon after they’ve been administered.

But in order for this value proposition to become a more widespread accepted practice, payers must adopt a view that incorporates the concept of value-based pricing. Traditional methods of reimbursement that are commonly used for  maintenance medications such as anti-hypertensives and anti-depressants, aren't applicable. As a result, payers will need to implement value-based pricing arrangements like pay-for-performance schemes or warranty programs. With these type of arrangements evidence is gathered and analyzed to assess whether a cell and gene therapy is proving effective  over time—on other words, as a drug yields positive, intended outcomes for a patient, the therapy’s value is proven.

There are more than 1,000 clinical trials of cell and gene therapies underway worldwide. Consequently, experts forecast a wave of new cell and gene therapy approvals in the coming years across numerous therapeutic areas, including several with very large sub-populations numbering millions. Invariably the question becomes how patients, and the healthcare systems, will pay for these therapies.

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Lyfegen is already working with payers and pharmaceutical companies to implement value-based pricing arrangements in multiple markets. The Lyfegen Platform is designed to enable more efficient and transparent management of value-based drug pricing contracts for cell and gene therapies by using intelligent algorithms to capture and analyze real-world, patient-level drug cost data. Additionally, the Lyfegen Model & Agreement Library contains over 18 innovative models and more than 2,000 agreements from global payers and pharma that can be invaluable resources when identifying the right model to propose during negotiations.

We proudly announce our role as contributors in the founding team of the newly established European Association of Value-Based Health Care (EAVBHC), launched at the European Parliament in Brussels this week. Girisha Fernando and Michel Mohler stand alongside visionary minds, leveraging their extensive expertise in value-based healthcare. We are delighted to offer our support to João Marques-Gomes, PhD, who serves as President of the Association and has been a member of the Lyfegen Advisory Board for many years.

EAVBHC represents a profound shift in European healthcare systems, moving away from supply-driven models to patient-centered care. The primary goal is to restructure healthcare by focusing on what truly matters to patients: improving outcomes, reducing costs, and enabling informed decision-making. Quality improvement, cost reduction, and empowering patients through data-driven answers are at the core of this new paradigm.

To achieve these goals, EAVBHC has launched various initiatives that will revolutionize healthcare practices:

The High Value Program engages with European politicians and decision-makers to integrate value-based healthcare principles into policies and actions. Through collaborative efforts, EAVBHC ensures that value-based healthcare becomes the cornerstone of healthcare systems across Europe.

The Centre for High-Value Care serves as a hub for scientific research, knowledge dissemination, and collaboration. Through research articles, case studies, and the European Research Consortium for VBHC, valuable insights and evidence are shared, empowering healthcare professionals with the knowledge to drive transformation in their organizations.

The VBHC Academy is committed to ensure that future clinicians and managers receive comprehensive training in value-based healthcare, shaping a new generation of healthcare leaders who will continue to build upon and push value-based healthcare  forward.

Our involvement in the EAVBHC is driven by our steady commitment to shaping healthcare, focusing on patient-centered care, and fostering a future where outcomes matter, costs are optimized, and healthcare decisions are data-driven. Our joint effort promises a brighter future, where value-based contracting makes a marked and meaningful difference in the lives of patients, ultimately improving the healthcare experience for all.

In the heart of innovation, where technology meets healthcare, Girisha Fernando, CEO of Lyfegen, stands as a beacon of transformation. We sat down with him to discuss the groundbreaking launch of the Lyfegen Drug Contracting Simulator, a tool set to revolutionize drug access, pricing and contracting.

Fernando begins by outlining the quintessential challenge that spurred the creation of this novel tool. “Drug access, pricing and contracting has been entangled in the complexities of payer negotiations for far too long. Traditional methods like manually modeling pricing and contracting scenarios are not just cumbersome; they’re archaic, in light of the innovative drugs we are seeing, such as gene therapies.”

On the quest for a solution that addresses the underlying issues such as uncertainties that prolong or event prevent access, and finding a win-win scenario that both pharma & payers are happy with, Lyfegen has developed a groundbreaking solution – the Lyfegen Drug Contracting Simulator. The innovation embodies Lyfegen’s ambition to streamline and revolutionize the drug pricing and contracting process.

“What we’ve created is not just a better Excel, but a solution - intuitive, real-time, limitless. It was made to close the gap between old practices and new innovations within the healthcare space. It’s the future of drug access.”

As we delve deeper into the conversation, Fernando's enthusiasm for the simulator's potential benefits becomes palpable. “It’s about accelerating strategies, saving time, and fostering better decision-making,” he asserts. “The Lyfegen Drug Contracting Simulator is a multi-faceted solution that combines drug pricing, contracting, and business case generation, all within a collaborative and innovative framework.” The uniqueness of the Lyfegen Drug Contracting Simulator lies in its features, as Fernando highlights.

“We’re talking about a simulator that not only runs real-world simulations but also provides data-driven insights to empower negotiations.” This level of sophistication, according to Fernando, addresses concerns beyond simple discounts and delves into the nuances of value-based and outcome-based contracting models. What strikes most about Fernando’s vision is incorporating AI to guide users on optimal pricing and rebate models. “In today’s world, the intelligent use of data is crucial. The simulator can help pharma and payers to become more efficient and successful.”

As our conversation nears its end, Fernando touches upon a crucial aspect – data security. “Data privacy is non-negotiable. Lyfegen is committed to rigorous adherence to international data privacy standards and state-of-the-art data security.” Fernando’s final thoughts encapsulate the essence of the Lyfegen Simulator. “The Lyfegen Simulator is a paradigm shift in how the pharmaceutical industry will approach drug pricing. It’s about turning uncertainty into understanding, and that’s a powerful change.”

As we part ways, it’s clear that the Lyfegen Drug Contracting Simulator isn’t just another product launch. It’s a vision brought to life, a testament to Fernando’s belief in the transformative power of technology in healthcare. With this launch, Lyfegen isn't just offering a solution; it's shaping the future of drug access and contracting.

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Learn more about it here.

U.S. and European healthcare payers are increasing their utilization of value-based drug pricing agreements to hold down drug costs, bring better value and improvements to health outcomes, and determine a fair price for new drugs. The question of who does the assessments to determine a drug’s fair price is answered differently in the EU than in the U.S.

National healthcare leaders have a common problem to solve and a common goal to achieve. The problem is how to protect national healthcare budgets from overwhelming drug costs without discouraging pharmaceutical manufacturers from developing new products. The goal is to provide populations with equitable access to innovative, safe, clinically effective, and cost-effective healthcare therapies.

In the U.S., payers and policymakers are trying to control drug expenditures and determine the value of new drugs in an opaque, free-market environment. In Europe, government price controls and centralized clinical and economic evaluations of new drugs are standard. For both these pharmaceutical markets, drug pricing agreements based on value instead of volume are gaining traction.

The problem: drug prices keep rising

Pharmaceutical sales in Europe are almost a quarter of all drug sales globally. From 2015 to 2020, the top five European markets–the UK, Germany, France, Italy, and Spain–accounted for 17.4% of sales of new drug therapies. These top five markets are predicted to increase spending by $51 billion through 2026.

North America is the largest pharmaceutical market, accounting for almost half of the total global sales. From 2015 through 2020, the U.S. purchased 63.7% of all the new medicines introduced. The U.S. is expected to increase drug spending by an estimated $119 billion through 2026.

According to IQVIA, a leading healthcare consulting firm, the change in drug spending in the U.S. and European markets through 2026 will be due, in large part, to new brands.

The goal: access to new, high-quality drug treatments at a fair price

Healthcare payers don’t want to take on the financial risk and clinical uncertainty of a new, high-cost pharmaceutical product. Payers want to provide patients with equitable access to innovative treatments that improve health outcomes, especially in therapeutic areas with unmet health needs.

Value-based drug pricing arrangements address these concerns with evidence-driven, outcome-based agreements. The payer and manufacturer share the risks of a new drug not performing as expected. In both the U.S. and the EU, payers and manufacturers are engaged in more finance-based drug pricing contracts than performance-based contracts–but this trend is shifting.

Assessing a drug’s value in the EU healthcare system

Value-based drug pricing arrangements are called managed entry agreements (MEAs) in Europe. MEAs between drug manufacturers and healthcare payers can be finance-based (FBAs), performance-based (PBAs), or service-based agreements (SBAs).

Unlike the U.S., the EU has a centralized system for assessing a drug’s value. Each EU member state has an agency that uses an evidence-based data gathering process called health technology assessments (HTAs). HTAs include nine domains for assessment–four clinical and five non-clinical–that evaluate the efficacy and added value of a new drug compared to other treatment options already available on the market.

The work of the member states’ HTA bodies is coordinated by the European Network for Health Technology Assessment (EUnetHTA). However, conclusions and decisions related to drug pricing and reimbursement remain de-centralized.

Coverage with Evidence Development (CED) may be a part of an MEA and come after the HTA. CED is a way for urgently needed treatments to come to market under conditional approval while real-world evidence continues to be collected. This additional data should help payers decide about coverage. CED use varies by country, with the most CED found in the UK and the U.S. (through Medicare).
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Related Post: Indication-specific pricing to make inroads in the U.S.‍

Assessing a drug’s value in the US healthcare system

The possibility of developing a centralized Health Technology Assessment for the U.S. Healthcare System was the focus and title of a white paper published in early 2020 by the University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics.

The white paper describes the complexities of creating a national HTA organization in the U.S. It examines the difficult dynamics of the many stakeholders in the healthcare system; few are operating with enough transparency and coordination with other stakeholders to support value-based drug pricing. The authors conclude that in the current polarized legislative environment in the U.S., an attempt to develop a national HTA organization would be met with strong political resistance.

In the absence of the European-style centralized HTA body, U.S. payers look to alternative sources for the data they need for drug pricing negotiations. Private and public payers may find clinical and economic evaluations from various agencies that do HTAs on a limited scale. These include government and independent organizations, such as the Department of Veteran’s Affairs, Medicaid, the Patient-Centered Outcomes Research Institute (PCORI), and the Agency for Healthcare Research and Quality (AHRQ). One of the most influential organizations in this space is the independent, non-profit Institute for Clinical and Economic Review (ICER).

Unfortunately, these organizations don’t do value-based pricing evaluations for every drug that comes on the market, and some of their work is not publicly available. Even if analysis of a selected drug is available, it may not cover the key metrics a customized value-based drug pricing agreement needs to track.

When real-world data about a drug’s performance is limited, it’s often up to the manufacturer and payer entering the value-based contract to develop the framework and the data collection and analysis capability, either in-house or through a third-party vendor.

The Lyfegen Solution

The Lyfegen Platform is a customizable solution for healthcare payers, pharma, and medtech companies who need to gather and analyze real-world evidence about a drug’s performance for value-based drug pricing agreements. Lyfegen’s value-based contracting software collects real-world data and uses intelligent algorithms to provide valuable insights into clinical effectiveness and costs.

Lyfegen’s contracting platform helps implement and scale value-based drug pricing contracts with greater efficiency and transparency. By enabling the shift away from volume-based, fee-for-service healthcare to value-based healthcare, Lyfegen increases access to healthcare treatments and their affordability.

To learn more about Lyfegen’s software solutions, contact us to book a demo.

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Basel, Switzerland / Boston, USA – December 11, 2024

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Lyfegen, a global leader in drug rebate management technology, today announced the successful close of its additional CHF 5 million Series A funding round. The round was led by TX Ventures, a leading European fintech investor, with additional participation from aMoon, a global health-tech venture capital firm, and other institutional investors. This funding represents a significant milestone for Lyfegen, enabling the company to accelerate its global expansion and innovation efforts, with a focus on extending its reach beyond Europe into new markets worldwide.

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Addressing Rising Drug Costs with Intelligent Drug Pricing and Rebate Solutions

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The healthcare industry faces increasing challenges with rising drug costs and the complexity of managing growing volumes of rebate agreements. For payers and pharmaceutical companies, manual processes often lead to inefficiencies, compliance risks, and operational delays. Lyfegen is transforming this process with its fully automated platform that ensures secure, real-time tracking, compliance, and operational efficiency at scale.

Today, 50+ leading healthcare organizations across 8 geographical markets rely on Lyfegen’s solutions to streamline 4'000+ rebate agreements while tracking over $1 billion in pharmaceutical revenue and managing over $0.5 billion in rebates annually. These solutions enable healthcare organizations to improve pricing strategies, accelerate access to modern treatments, and better manage rebate complexities.

Learn more about Retrospective Payment System

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Scaling Globally with a Leading Rebate Management Platform

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Already used by healthcare payers and pharmaceutical companies in Europe, North America, and the Middle East, Lyfegen’s platform is poised for broader global deployment. By automating rebate management, the platform enables healthcare organizations to simplify complex agreements, save time, reduce errors, and enhance financial performance.

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“The market for innovative and personalized treatments is expanding rapidly, but with that comes increasingly complex and costly pricing models,” says Girisha Fernando, CEO of Lyfegen. “Lyfegen’s automated solution simplifies this complexity, helping payers and pharmaceutical companies unlock the full potential of rebates while improving patient access to modern treatments. With this funding and our new partners, we’re ideally positioned to accelerate our growth and make a meaningful impact globally.”

Jens Schleuniger, Partner at TX Ventures, adds: “Lyfegen is at the forefront of innovation, offering payers and pharmaceutical companies a powerful solution to address the rising complexities of pharma rebates. We’re proud to lead this funding round and support Lyfegen’s mission to bring greater efficiency and cost savings to healthcare systems worldwide.”

About Lyfegen

Lyfegen is an independent provider of rebate management software designed for the healthcare industry. Lyfegen solutions are used by health insurances, governments, hospital payers, and pharmaceutical companies around the globe to dramatically reduce the administrative burden of managing complex drug pricing agreements and to optimize rebates and get better value from those agreements. Lyfegen maintains the world’s largest digital repository of innovative drug pricing models and public agreements and offers access to a robust drug pricing simulator designed to dynamically simulate complex drug pricing scenarios to understand the full financial impact. Headquartered in Basel, Switzerland, the company was founded in 2018 and has a market presence in Europe, North America, and the Middle East. Learn more at Lyfegen.com.

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About TX Ventures

TX Ventures is one of Europe’s emerging leaders in early-stage fintech investing. The venture capital fund invests predominantly in B2B Fintech across Europe - preferably in seed to series A stage. 

For more information about Lyfegen’s solutions or to schedule an interview, please contact:
marketing@lyfegen.com 

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In an industry often characterized by incremental changes, Girisha Fernando, the CEO and founder of Lyfegen, is making leaps. We sat down with Fernando to discuss the recent landmark partnership between Lyfegen and Newfoundland and Labrador Health Services—a collaboration that heralds a significant shift in the Canadian healthcare landscape.

Your partnership with Newfoundland and Labrador Health Services is quite a milestone. Can you share with us what this means for the current state of rebate management in Newfoundland?

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Girisha Fernando (GF): Absolutely. This partnership is a transformative step for rebate management in Newfoundland. The current system, largely manual and complex, is ripe for innovation. With our digital platform, we're bringing a level of automation and accuracy that was previously unattainable. This means more efficient processing, less room for error, and a better allocation of resources, which is critical in healthcare.

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That’s quite an advancement. And how does this impact the management of drug products, especially in areas like oncology?

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GF: It’s a game-changer, especially for critical areas like oncology. Newfoundland and Labrador, as the first in Canada to use our platform, sets a precedent. The region, through the pan-Canadian Pharmaceutical Alliance, has been managing complex product listing agreements for drugs, including those for oncology. These agreements are vital for making treatments affordable. Our platform simplifies this, managing the various terms of these agreements efficiently, which is crucial for timely and affordable access to treatments.

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It seems like a significant step forward for healthcare management. How does this align with the broader goals of Lyfegen?

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GF: This partnership aligns perfectly with our goal to make healthcare more accessible and efficient. Automating the rebate process in Newfoundland and Labrador, especially for critical treatments in oncology, directly contributes to the sustainability and accessibility of healthcare treatments.

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Looking to the future, what does this partnership mean for Lyfegen and healthcare systems globally?

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GF: This is just the beginning. We're looking to extend our platform to healthcare systems around the world. Our aim is to make this technology a standard in healthcare management, fostering more efficient, sustainable, and equitable healthcare systems globally.

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Read more about the partnership in the official press release.

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Basel, Switzerland, October 27, 2021

Lyfegen announces that Swiss health insurance Sympany is using the Lyfegen Platform to implement & execute complex drug pricing models. Sympany applies the Lyfegen Platform to execute and efficiently manage all value and data-driven pricing models. Sympany gains efficiency and transparency in managing pricing models with the Lyfegen Platform. It offers many pricing models, including pay-for-performance, combination therapy and indication-based models.

The Lyfegen Software Platform digitalises all pricing models and automates the management and execution of these agreements between health insurances and pharmaceutical companies. This is done using real-world data and machine learning enabled algorithms. With the Lyfegen Platform, Sympany is also creating the basis for sustainably handling the increasing number of value-based healthcare agreements for drugs and personalized Cell and Gene therapies. These new pricing models allow health insurances to better manage their financial risk by only paying for drugs and therapies that benefit patients.

"The Lyfegen Platform helps Sympany execute complex pricing models efficiently, securely and transparently. We are pleased to extend our pioneering role in the health insurance industry by working with Lyfegen. This is another step for Sympany to provide our customers with the best possible access to therapies in a sustainable way," says Nico Camuto, Head of Benefits at Sympany, about the use of the Lyfegen Platform.

Girisha Fernando, CEO of Lyfegen, says: "We are very proud to support Sympany in strengthening its focus on value creation, efficiency and transparency amidst the growing complexity of pricing models. It is clear that the trend is increasingly towards complex pay-for-performance arrangements. Ultimately, our goal is to help patients receive their much-needed treatments while helping health insurances better manage risk and cost."

The Lyfegen Platform aims to help patients access innovative medicines and treatments by enabling innovative drug pricing agreements. The Platform collects and analyzes real-time pricing data, allowing health insurances and pharmaceutical companies to obtain relevant information on drug benefits and related financial planning.

About Sympany

Sympany is the refreshingly different insurance company that offers tailored protection and unbureaucratic assistance. Sympany is active in the health and accident insurance business for private individuals and companies, as well as in the property and liability insurance business, and is headquartered in Basel. The group of companies under the umbrella of Sympany Holding AG comprises the insurance companies Vivao Sympany AG, Moove Sympany AG, Kolping Krankenkasse AG, and Sympany Versicherungen AG, as well as the service company Sympany Services AG.

In 2020, profit amounted to CHF 68.8 million, of which Sympany allocated CHF 27.5 million to the surplus fund for the benefit of its policyholders. Total premium volume amounted to CHF 1,058 million. With 575 employees, the company serves around 257,100 private customers, of which around 204,500 are basic insurance policyholders under the KVG. In the corporate customer business, Sympany offers loss of earnings and accident insurance.

More about Sympany: https://www.sympany.ch

About Lyfegen

Lyfegen is an independent, global software analytics company providing a value and outcome-based agreement platform for Health Insurances, Pharma, MedTech & Hospitals around the globe. The secure Lyfegen Platform identifies and operationalizes value-based payment models cost-effectively and at scale using a variety of real-world data and machine learning. With Lyfegen’s patent-pending platform, Health Insurances & Hospitals can implement and scale value-based healthcare, improving access to treatments, patient health outcomes and affordability.

Lyfegen is based in the USA & Switzerland and has been founded by individuals with decades of experience in healthcare, pharma & technology to enable the shift away from volume-based and fee-for-service healthcare to value-based healthcare.

Contact Press: press@lyfegen.com

Contact Investors: investors@lyfegen.com

READ THE OFFICIAL PRESS RELEASE

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New York, NY - March 29, 2023 - Lyfegen, a global healthtech SaaS company driving the world’s transition from volume to value-based healthcare for high-cost drugs, announced at the World EPA Congress the launch of its latest solution: the Model & Agreement Library. The purpose of the library is to help payers and pharma negotiate better drug prices while providing an in-depth view on current international drug pricing models and value-based agreements. The database library serves as the basis for successful drug pricing negotiations, resulting in accelerated access and drug prices better aligned to their value for the patient.

The shift towards value-based healthcare, rather than volume-based, has been steadily increasing over the years. This evolution has further reinforced Lyfegen's mission to remain at the forefront of analytics and digital automated solutions for the healthcare sector. Indoing so, Lyfegen’s solutions help to accelerate access and increase affordability of healthcare treatments.

“Because of rising healthcare costs and the increase of medical innovations, the thirst for knowledge and need for value-based healthcare capabilities has surged among healthcare payers, and pharma companies across the world”, said Girisha Fernando, CEO of Lyfegen. “That is why we are so excited about launching the world’s largest database of real-world value-based agreements. It gives payers, and pharma a unique insight into how to structure value-based agreements.”

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The Lyfegen Model & Agreement Library was developed as an accelerated negotiation resource for both manufacturers and payers – allowing them to save on time, money; and for the first time – an opportunity to learn at their own pace without incurring large research projects or hiring expensive external experts. Users of the library are now enabled to make informed decisions in determining the most suitable drug pricing models and agreements for their products.

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The database holds over 2'500+ public value-based agreements and 18+ drug pricing models – spanning across 550 drugs,35 disease areas and 150 pharma companies. Its search capabilities are spread across product, country, drug manufacturer and payer – with all the knowledge, insights, current pricing and reimbursement activities shown in near real-timeacross the industry.

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“Just an academic taxonomy of models is intellectually exciting but it's not really helping your typical customer”, said Jens Grüger, Director and Partner at Boston Consulting Group (BCG). “The Lyfegen Platform goes several steps further. Payers and pharma have a problem and they want a solution. The Lyfegen Model & Agreement Library is practical. It offers case examples.”

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Looking for a Pharmaceutical Healthcare Solution?
Get personalized advice and take the next step in optimizing your healthcare strategy with innovative solutions designed for the pharmaceutical industry.

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The Model & Agreement Library lets the user see the specifics of agreements reached between manufacturers and payers, including which disease areas and drug/device innovations were targeted. This market-leading database allows for one-to-one comparisons of agreements while heightening increased leverage during the negotiations process.

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“I like having a palette of contracts that fall under different domains, like disease state, the way the drug is administered, or available evidence. There are different ways to make a contract attractive to us, to pharma, and to our physicians”, said Chester Good, Senior Medical Director Center for Value Based Pharmacy Initiatives at UPMC Health Plan.

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This resource represents a breakthrough in the healthcare industry that facilitates the sharing of knowledge – a strong point of discussion that is becoming increasingly more important. Lyfegen is currently providing a limited time opportunity for industry professionals who are interested to try out the Model & Agreement Library with a complimentary 7-day trial.

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Learn more and start your free trial now

Basel, Switzerland, August 3rd, 2021

Lyfegen announces that its value-based healthcare contracting platform has been implemented together with Johnson & Johnson Medical Devices Companies Switzerland (Johnson & Johnson) and a leading Swiss Hospital.  

Through this new value-based healthcare approach, Lyfegen and its partners drive the shift towards what matters most to patients: improved patient health outcomes and more efficient use of financial and human resources, enabling a sustainable post-COVID-19 healthcare environment.  

The shift towards a value-based healthcare in Switzerland and globally can only be achieved through the support of innovative technologies. Lyfegen’s platform is a key enabler for this transition. The platform digitalises and automates the execution of value-based healthcare agreements, paving the way for the resource-efficient scaling of such novel agreements.   

“COVID-19 has shown us the urgent need for a more sustainable healthcare system. With the implementation of value-based healthcare agreements on the Lyfegen platform, we are extremely proud to help Johnson & Johnson and hospitals to accelerate the transition to value-based healthcare and improve patient health outcomes at reduced cost.” says Lyfegen’s CEO, Girisha Fernando.

Lyfegen's compliant, secure and patent-protected value-based healthcare contracting platform automates the collection and analysis of patient-level data. Users receive transparency on actionable health outcomes and agreement performance. Lyfegen’s contribution to this partnership is a blueprint for the scaling of value-based healthcare models across hospitals, health insurances, medical device & pharma companies globally. The partnership marks another important milestone for Lyfegen, as the company continues to grow and has recently opened its next investment round.  

READ THE OFFICIAL PRESS RELEASE

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Each year, the NAMD (National Association of Medicaid Directors) Conference in Washington D.C. brings together the nation's Medicaid directors, leaders in the industry, and key decision-makers for a one-of-a-kind conference. With the global public health emergency, the Medicaid system and the work of Medicaid directors and their staff has never been more important. While COVID-19 has disrupted health care at all levels, it has shown the importance of more innovative payment models and the need for broader access to treatments. The shift towards value-based healthcare has become one of Medicaid’s hottest topics, with CMA and Lyfegen joining forces to present the latest value-based contracting technology at this year’s NAMD Conference.

We sat down for a brief interview with CMA’s President, Ken Romanski, and Lyfegen’s CEO, Girisha Fernando, to gain more insights into the importance of this partnership:

Thanks for joining us, Ken and Girisha. Can you tell us why this partnership is an important milestone, both for CMA and Lyfegen?

Ken: Our partnership with Lyfegen is a key milestone for CMA as we expand and complement our portfolio of technology-based solutions with extremely high-value business analytics products. Our utmost priority is to support Medicaid programs by lowering costs, while at the same time improving health outcomes for vulnerable citizens.

Girisha: This partnership sets the basis to create enormous value for our state healthcare payers and pharma. By partnering together, we enable our customers to implement value-based pharmacy agreements, actively managing the budget impact of new treatments and aligning existing formulary spending with value for beneficiaries.

For Lyfegen, this is a market entry into the U.S. – why CMA?

Girisha: CMA’s experience and technical expertise are unique. CMA is a highly recognized technology partner for State Healthcare Payers across the nation, with over 20 years of experience. Lyfegen has made a conscious decision to combine its capabilities with CMA to enable our customers to leverage the potential of value-based agreements for their pharmacy programs.

What is the value of this partnership for healthcare payers?

Ken: CMA is very excited to work with Lyfegen and our clients to deliver tens of millions of dollars in savings per year by leveraging our experience in Medicaid data management to implement this robust value-based analytics platform.

Girisha: Our customers benefit from the combined years of experience and unique expertise in data and value-based healthcare solutions. We focus on providing the first proven, scalable, highly secure value-based agreement platform for State Medicaid that allows our customers on average to avoid 54 million dollars in treatment costs that do not work and gain 7 million dollars in efficiency due to the fully automated end-to-end process. We are extremely excited to present all aspects of our partnership and present the value and opportunities our platform can bring to State Medicaid programs at NAMD.

Join CMA and Lyfegen at NAMD and understand first-hand how they can support you to realize savings for your pharmacy programs, improving patient health outcomes with their unique value-based agreement platform.

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                    Fünf Männer aus der Region wollen die Gesundheitsbranche aufmischen. Im 2018 wurden sie von der Plattform «Innovation Basel» für ihre visionäre Idee nominiert: Eine digitale Plattform, die eine Kombination aus Blockchain und Cloud verwendet, um faire Medikamentenpreise zwischen Herstellern und Versicherungen auszuhandeln. Was heisst das aber und was ist dabei so visionär?            

                    (Bild: zVg) Das Lyfegen Team: Diese fünf Männer haben eine Vision und eine Mission. Die Idee liess Girisha Fernando nicht mehr los: Der 29-jährige Basler wollte nach neun Jahren bei der Roche im Market Access, Pricing und IT unbedingt «etwas noch Spannenderes, Revolutionäres machen», wodurch Patienten im Dschungel des Gesundheitswesens geholfen wird. Aber es sollte dabei auch für Pharmaunternehmen und Versicherer eine Win-Win-Situation entstehen.          

         Zusammen mit seinen Mitstreitern Leon Rebolledo, Michel Mohler und Nico Mros gründete er 2018 «Lyfegen» und entwickelte eine bahnbrechende Idee: Eine auf Blockchain und Cloud basierte Software Lösung, die es Versicherern und Herstellern von Medikamenten erlaubt faire Preise anhand deren Wirksamkeit für den einzelnen Patienten auszuhandeln.                      

            Faire Preise bedeuten unter anderem auch, dass die Vergütung dieser Medikamente auf der Wirkung des Medikaments basiert. Wenn ein Medikament bei einem Patienten besser wirkt, dann wird ein Preis A bezahlt. Wenn ein Medikament bei einem anderen nicht so gut anschlägt, dann wird Preis B vom Versicherer an den Hersteller fällig oder sogar nichts bezahlt. Unser Tool ermöglicht genau diese faire, wirkungsorientierte Preisgestaltung, was sich auch Value-based Healthcare nennt. So ein Tool gibt es auf der ganzen Welt bisher nicht.             Name Surname
Position, Copmany          

                 Fachleute sprechen hierbei von «Wertbasierter Gesundheitsversorgung». Dieses Thema ist aktueller denn je, auch in der Schweiz, in der steigende Behandlungs- und Medikamentenpreise zu höheren Kosten für die Bevölkerung führen. Es müssen neue, nachhaltige Modelle eingeführt werden, um die Kostenexplosion im Gesundheitswesen aufzuhalten.          

         Transparenz bei Preisgestaltung und Wirkungsgrad          

Warum aber ist so ein Tool wertvoll? «Weil unser Tool Daten sicher sammelt, analysiert und dann den jeweiligen Partnern, sei es ein Versicherer oder ein Hersteller wie Pharmaunternehmen, die Daten anonym, automatisiert und gleichzeitig zuspielt.» Dies geschieht mit Hilfe der Blockchain (eine dezentralisierte Form der Datenverarbeitung und -sicherung, die beispielsweise Geldeinheiten, Wertpapiere, Besitz- oder Grundrechte verwaltet, siehe Erklärung in der Infobox), ganz ohne Kryptowährung, betonen die fünf innovativen Köpfe.

                     (Bilder: PEXELS) Im Gesundheitswesen explodieren die Kosten. Eine revolutionäre Idee könnte dieser Entwicklung entgegen wirken.            

            Die Idee hat schon für viel Wirbel in der «Szene» gesorgt. Und sie gehen mit ihrer Idee aufs Ganze: «Wir haben schon 750’000 CHF von einer Gruppe von Basler Business Angels erhalten», sagen die Lyfegen-Gründer. Diese Business Angels seien selbst erfolgreiche Unternehmer. Namen dürfe man leider keine bekannt geben. Zudem müsse man zu 100 Prozent hinter einer Innovation, einer Vision oder einer Idee stehen, die der Gesellschaft helfen könne, betonen sie. Fernando: «Ich bin fest davon überzeugt, dass nicht nur unsere Lösung, sondern auch die Denkprozesse, die wir bei unseren Kunden anregen, die Implementierung einer wertbasierten Gesundheitsversorgung vorantreibt. Konzept und Lösung sind innovativ.»                        

               Vertrauen und Transparenz zwischen Ärzten und Patienten ist immens wichtig. Darauf basiert auch das Konzept des Value-based Healthcare.      

      Zwar sei man bei Lyfegen sehr technisch veranlagt, jedoch steht der Kundennutzen und der so genannten «Impact» für alle Parteien im Vordergrund. Also auch für die Versicherten und für das gesamte Gesundheitswesen. «Unsere Lösung trägt dazu bei, Patienten Zugang zu innovativen Behandlungen und der bestmöglichen Gesundheitsversorgung zu ermöglichen. Wir wollen Leben retten. Punkt», betont CTO Leon Reborello. Girisha Fernando kann aus eigener Erfahrung berichten: «Mein Grossvater hatte Prostatakrebs und die Ärzte sagten, dass es Medikamente gibt um seine Lebensdauer zu verlängern. Aber die Versicherung wollte aus Kostengründen nicht für das Medikament bezahlen. Dies muss aufhören – durch wertbasierte Vergütung würden die besten und innovativsten Medikamente für Patienten und Ärzte zugänglich. Mit unserer Lösung tragen wir dazu bei, dies zu verwirklichen.»