Under value-based drug pricing, the cost of a prescription medication reflects the value of the health benefit patients receive from the drug. Patients gain better access to effective, high-priced prescription medications, while health insurers manage financial risk and reduce healthcare costs.

U.S. consumers are paying more for prescription drugs

Patients in the U.S. pay the highest prices in the world for prescription drugs. How much higher? Here’s an example:

According to a 2020 study by RAND Health Care, the manufacturer’s average price per standard unit of insulin in the U.S. is $98.70 compared to an average price of $8.81 in other industrialized countries.

Another 2020 study by the U.S. Government Accountability Office (GAO) shows that, even after discounts and rebates, American consumers and health insurers pay more than double for most prescription drugs when compared to patients and insurers in other industrialized countries. Estimates included in a recent report from the Department of Health and Human Services (DHS) to the White House reveal patients who use prescription medications spend an average of $1,567 per person on prescription drugs each year.

High drug costs affect patient health outcomes

Patients may forgo treatment when high drug prices make healthcare too expensive. A recent poll of 1,526 adults conducted by the Kaiser Family Foundation (KFF) revealed about 3 out of 10 survey respondents had not taken their medications as prescribed over the last 12 months because of the cost.

Twenty-five percent of those surveyed reported taking four or more prescription drugs—members of this group were more likely to report difficulty affording their prescriptions. Instead of taking their medications as prescribed, the KFF survey found patients who had trouble paying for their medications often did one or more of the following:

• • Didn’t fill the prescription
• • Skipped doses or cut pills in half
• • Substituted with an over-the-counter medication

Value-based drug pricing improves health outcomes

Value-based pricing relates the cost of a drug to the clinical benefit patients receive from the drug. When executed correctly, value-based healthcare (VBHC) contracts give patients greater access to effective treatments to improve their health outcomes while insurers pay drug prices that are in line with the value of the health benefit the drug offers.

Determining which drugs produce the greatest positive impact on health outcomes relies on the enormous task of collecting and analyzing patient-level healthcare data. One of the important ways VBHC contributes to better patient outcomes is by providing reliable, actionable, real-world data about healthcare costs.

When real-world data about a high-priced drug shows limited health benefits—or the same benefit as a similar, lower-priced drug—insurers can restrict access to the high-priced drug by requiring strict prior authorizations or increasing patient cost-sharing. When real-world data show a drug is effective, safe, and cost-effective relative to other treatments on the market, both healthcare providers and insurers work to facilitate access to that drug for patients who need it.

The Lyfegen Platform supports the transition to value-based healthcare

Lyfegen has developed a software platform that helps health insurance companies, hospitals, pharmaceutical companies, and medical device manufacturers manage value-based drug pricing contracts with greater efficiency and transparency. The Lyfegen platform uses machine learning to collect and analyze patient-level drug cost data to execute complex pay-for-performance agreements.

If your organization is considering the transformation from fee-for-service to value-based healthcare, Lyfegen can help. Contact us to learn more and to arrange a free demonstration of our platform.

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The high-costs of newer drug treatments make the adoption of non-traditional, value-based drug purchasing arrangements a necessity for healthcare payers and administrators trying to manage their budgets, provide patients with quicker access to the most effective treatments, and reduce wasteful spending on treatments that don’t work. Recent regulatory changes and advanced AI contracting software options are making value-based drug pricing arrangements easier.

Even before the onset of the pandemic, annual budgets for public and private healthcare insurers were strained by the high and increasing costs of prescription drugs. Meanwhile, pharmaceutical manufacturers are bringing new and even more expensive drug treatments to market each year. According to Bloomberg, the median list price for a year’s supply of a new drug introduced to the U.S. market in 2021 was $180,007.

Thanks to COVID-19 vaccines and COVID-related treatments, pharmaceutical sales reached record levels in 2021. Sales in North America account for close to half of the total $7.3 billion global market revenue for that year. And since prescription drug prices are higher in the U.S. than anywhere else in the world, the increasing costs of drugs are a top concern for policy makers, healthcare payers, and consumers.

New, more expensive drug therapies are in development

A growing niche and focus for pharmaceutical companies is high-cost cell and gene therapy products. Market analysis by Grand View Research forecasts the global cell and gene therapy clinical trials market to reach a compound annual growth rate of close to 15% and an estimated market revenue of USD 24.5 billion by 2030.

While the U.S. Food and Drug Administration (FDA) has approved only a limited number of cell and gene therapies so far, expedited approvals of new drugs and favorable designations of new therapies as orphan drug or breakthrough therapies support increasing consumption of these new drug therapies in the U.S. market. The FDA predicts that by 2025, it will approve up to 20 cell and gene therapy products a year.

Healthcare payers and consumers feel the pain of higher drug prices

Even though payers are getting rebates and not paying drug manufacturers’ full list prices, they still have cause for concern as drug prices increase annually. Payers need to protect their annual budgets from outsized expenditures, especially for specialty drugs.

Both payers and patients suffer the effects of high and increasing drug prices. A study of 14.4 million pharmacy claims made from 2010 to 2016 revealed the median healthcare insurer payments for specialty medications rose by 116%; the median patient out-of-pocket costs increased by 85%. Drug list prices during the same 7-year period more than doubled, rising faster than inflation.

Drug manufacturers recognize the need for non-traditional, value-based payment arrangements

A new cell or gene therapy’s price tag may generate as much attention as the drug’s ability to treat disease. For example, one of the most expensive drug therapies in the world is Zolgensma, approved by the FDA in 2019. Novartis Gene Therapies (formerly AveXis) developed the drug to be a cure for around 500 infants born each year in the U.S. with spinal muscular atrophy (SMA). A full course of treatment is priced at $2.125 million.

Soon after Zolgensma received FDA approval, some of the top U.S. insurers quickly set up tight restrictions limiting coverage of the treatment. To help payers manage the impact of the cost and ensure patient access to Zolgensma, Novartis offers insurers the option of either a 5-year, pay-over-time contract or an outcome-based agreement.

The list price of Zyntelgo, the latest gene therapy to be approved by the FDA, surpassed Zolgensma as the world’s most expensive one-time drug therapy. Zyntelgo was developed by bluebird bio as a single-use treatment for an inherited blood disorder, beta thalassemia. According to bluebird, Zyntelgo’s price of $2.8 million is a good value when compared to the estimated $6.4 million worth of lifetime care costs for a patient living with beta thalassemia.

Estimates suggest that only around 850 patients in the U.S. will meet the criteria for treatment with Zyntelgo, and not all of those who are eligible will want the drug. Predictions of Zyntelgo’s annual sales revenue range from $64 million to $200 million.

The majority of patients eligible for Zyntelgo are covered by commercial health insurance, with most of the rest using Medicaid. Bluebird is offering payers a sizeable refund if the treatment underperforms or fails. If patients still need blood transfusions within two years after receiving Zyntelgo, bluebird will refund the payer up to 80% of the treatment’s costs.

Payers recognize the benefits of using value-based drug pricing agreements

Outcome-based agreements help payers address any uncertainty about the effectiveness of a new treatment, gain insight into a drug’s value to patient health outcomes, and reduce the risk of overpaying for a low-value treatment. The real-world evidence collected while managing value-based drug arrangements helps manufacturers justify their list price and reinforces refunds and rebates to the payer if the treatment doesn’t deliver results as expected. So why has there not been greater use of value-based drug agreements?

Regulatory barriers to value-based drug purchasing arrangements eliminated

This year, U.S. legislators have addressed most of the legislative hurdles that, in the past, hindered value-based drug purchasing arrangements. Policymakers updated two pieces of legislation to support increased adoption of value-based drug pricing agreements.

The Medicaid Best Price rule was changed in July, allowing pharmaceutical manufacturers taking part in Medicaid to report multiple best prices. This was followed by the passage of the the Inflation Reduction Act in August, which allows Medicare to negotiate directly with drug manufacturers over the prices of some of the most expensive drugs covered by the Medicare program.

Overcoming technological challenges to implementing value-based drug agreements

Another significant obstacle to increased adoption of value-based drug pricing arrangements has been the difficulty in operationalizing complex, data-driven, outcome-based contracts. These non-traditional agreements require a powerful, interoperable contracting software platform with extensive data collection and analysis capabilities to make real-world evidence both accessible and insightful.

To take on an outcome-based contract, an organization has two options. The first is to develop the IT framework in-house and devote management resources to monitor compliance and data security. This option is expensive, time-consuming, and beyond the current capabilities of many organizations.

The second option is to outsource the administrative burden of an outcome-based contract. In recent years, third-party vendors have developed comprehensive contracting software to bridge the gap and help manufacturers, payers, and providers transition from fee-for-service into value-based agreements.

The Lyfegen Solution

Lyfegen is an independent, global analytics company that offers a software-as-a-service platform for healthcare insurances, pharma, and medtech companies wanting to participate in value-based drug pricing agreements without making large investments in software upgrades. With extensive industry expertise and a vast library of resources, we can assess your current capabilities and advise and guide you through pre-implementation. Deployment of our customizable and scalable contracting platform is quick and integrates seamlessly into your existing workflow without compromising data security or compliance.

Lyfegen’s software platform includes three-fold functionality to implement value-based, data-driven agreements with greater efficiency and transparency: data ingestion, agreement execution, and insights generation. The Lyfegen Platform collects real-world data and uses intelligent algorithms to provide valuable information about drug performance and cost.

By enabling the shift away from volume-based and fee-for-service healthcare to value-based healthcare, Lyfegen increases access to healthcare treatments and their affordability.

To learn more about our services and the Lyfegen Platform, book a demo.

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Innovation Center is Shifting Focus from Medicare to Medicaid

The U.S. Department of Health and Human Services is revamping value-based payment models, which it pursues at its so-called “Innovation Center” or Center for Medicare and Medicaid Innovation (CMMI). The CMMI implements alternative payment models in the government programs Medicare and Medicaid for the purpose of cost containment and improvement in quality of care.

Since its founding in 2010, CMMI has launched more than 50 alternative payment models. An oft-cited success story is the Medicare Part D (outpatient drugs) Senior Savings Model, which the Innovation Center set in motion to test the impact of offering Medicare beneficiaries prescription drug plan options that include comprehensive coverage of all insulin products – including medical devices - with considerably lower out-of-pocket costs. Thanks to a robust public-private partnership between the Centers for Medicare and Medicaid Services (CMS) and entities with whom it contracts - Medicare Advantage and Medicare Part D plans, as well as pharmaceutical companies - this model has achieved the goals laid out by the Innovation Center, which include cost savings, improved quality of care, and more equitable outcomes.

The CMMI payment models – sometimes called demonstration projects - are viewed as ways to bypass statutory or legislative obstacles, for the purpose of experimenting with new approaches to reimbursement. Though often piecemeal in nature, demonstration projects can be a fallback option if legislative efforts fail, as they appear to have done with the Build Back Better Act which is currently on ice.

For example, CMMI payment models are incorporating bundled payments for treatment episodes, to reduce Medicare Part B (physician-administered) drug spending through more prescribing of biosimilars and generics and a streamlining of healthcare services.

The CMMI is now shifting some of its focus of alternative payment models from Medicare to Medicaid. Continued Medicaid expansion appears to the impetus behind efforts by policymakers to prioritize equity and reduce inequality in health outcomes. Total Medicaid enrollment has grown to 86 million, an increase of 20% since February 2020.

In October of last year, the policy and programs group director at CMMI, Ellen Lukens, said that “models have been predominantly Medicare-oriented, and have disproportionately served white beneficiaries.” By contrast, relatively few models have centered around Medicaid beneficiaries, many of whom are minorities. That is about to change.

The CMS administrator, Chiquita Brooks-LaSure, has laid out a vision for the next decade, one in which CMMI will drive “meaningful change” towards an “equitable” and “value-based system of healthcare.”

To carry out the mission of improving equity, policymakers will explicitly address barriers to participation in CMMI payment models by healthcare providers that serve a high proportion of minority populations. Policymakers also want to entice more underserved patients to register to participate in pilot programs.

The CMMI has undertaken a major review of the Center’s existing payment models to determine what works and what doesn’t. The review calls on the Innovation Center to explore new forms of value-based models in Medicare and especially Medicaid. Here, payment would be tied not only to improved patient outcomes and decreased overall healthcare spending, but also reductions in health disparities and increased patient affordability (lower out-of-pocket costs). Partnering with Lyfegen may be the solution for manufacturers and payers alike, as Lyfegen's value-based payment solution is already widely being used by payers and pharma manufacturers in Europe.

As the Innovation Center embarks on a quest to improve the Medicaid program, using alternative payment models, it may need to consider adjusting its criteria of what counts as a successful model. The equity parts may be easier to measure than certain other objectives. For example, lowering federal expenditures appears to be the overriding goal of the CMMI models, and therefore cost savings to the government their standard measure of success. But, depending on the disease area in question, sometimes cost savings might not be easily achievable, even if the model is very much worth it and may save beneficiaries out-of-pocket expenses. In certain disease areas, improved health outcomes might be a better objective, along with a cost-effective use of additional resources.

About the author

Cohen is a health economist with more than 25 years of experience analyzing, publishing, and presenting on drug and diagnostic pricing and reimbursement, as well as healthcare policy reform initiatives. For 21 years, Cohen was an academic at Tufts University, the University of Pennsylvania, and the University of Amsterdam. Currently, and for the past five years, Cohen is an independent healthcare analyst and consultant on a variety of research, teaching, speaking, editing, and writing projects.

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In light of Swiss National Day on August 1st, Lyfegen’s CFO Michel Mohler gives his take on the recently released European Innovation Scoreboard & the role of the Swiss HealthTech industry.

A month ago, the European commission released the European Innovation Scoreboard, which provides a comparative analysis of innovation indicators between EU/European countries and regional neighbors. Based on scores for 27 separate indicators, the countries fall into four performance groups: Innovation Leaders, Strong Innovators, Moderate Innovators, and Modest Innovators.

Switzerland is the overall Innovation Leader in Europe, outperforming all EU Member States, as shown in the figure below.

Are we surprised? Since 2012, Switzerland’s performance relative to the EU countries has improved by 22.6% points. This being the second year where the Switzerland’s innovation score even surpassed the United States.

While most know Switzerland for its banks and timely precision, this little country has positioned itself globally as an innovation leader, scoring particularly high due to certain innovation dimensions. For the purpose of simplicity, we will focus on the three dimensions scoring the highest in relation to the EU.

1) “Human resources”: Switzerland scored particularly high when analyzing the quality of talent: this mainly being compromised of new doctorate graduates, population with a tertiary education and lifelong learning.

2) “Attractive research systems”: An attractive research ecosystem, leading in international scientific publications, most cited publication, and foreign doctorate students.

3) “Firm investments”: Overall company innovation and R&D expenditure.

Keeping in mind that the European Innovation Scoreboard is not specifically oriented towards indicators within the healthcare industry, it is unquestionable that the above mentioned dimensions are strongly influenced by the country’s leading position in Healthcare. Life Sciences being a pillar of the above seen growth, strongly dependent on skilled workforce and continuous innovation.

Lyfegen’s headquarters being in Basel, Switzerland, is not coincidental and allows us to be on the forefront of healthcare innovation, contributing actively.

The innovative Swiss ecosystem partnered with Lyfegen’s solutions and patent-pending technology are doubtlessly a winning combination for saving patient lives and driving Swiss innovation forward!

Read the Full report

Sources:https://ec.europa.eu/commission/presscorner/detail/en/qanda_20_1150

Value-based contracting focuses on patient outcomes by identifying value-based and outcomes-based measurable goals. By creating a set of outcomes as well as how to best measure them – value-based pricing for therapies can be determined.

As you can see – value-based contracting requires a lot of moving pieces and agreed-upon standards. This leaves the question of how best to facilitate these value-based healthcare agreements? The answer lies with Lyfegen.

Lyfegen works as a neutral third party with healthcare payers and manufacturers to implement a new way of paying for high-cost prescription drugs: value and outcome-based pricing and contracting. This groundbreaking platform enables patients to receive the best treatments and live a better and longer life.

With its innovative technology platform, Lyfegen is the catalyst for these entities to define, agree, and execute value-based and outcome-based pricing agreements while keeping costs at a sustainable level – allowing patients to receive innovative therapies at the right time and for the right price.

Lyfegen is the first of its kind, a company created to help patients in need. Lyfegen makes value-based healthcare contracting for high-cost therapies a reality for all healthcare stakeholders. With our expertise and secure state-of-the-art platform – we are trusted by some of the largest manufacturers, healthcare payers, and care providers in the world.

Lyfegen generates value-based contracts which combine outcome-based, pay-for-performance, and risk-sharing philosophies – creating value that matters:

-Better outcomes for patients-Accelerate, broaden, & sustain access to healthcare innovation-Facilitate & incorporate pay for performance healthcare pricing models-Improve appropriate use & compliance of treatments

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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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.”

Learn more about Pharmaceutical Healthcare Solution

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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, 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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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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Join in from anywhere in the world for two hours of incredibly interesting presentations by industry experts all around the topic of value-based healthcare.

At this DayOne Experts event, organized in close collaboration with Deloitte, industry experts will give an overview of where the pay-for-performance discussion in healthcare stands; possible solutions; and show how value-based healthcare could, should, and will impact the industry.

During the webinar, which will include deep dive sessions, we will seek answers to some of the most pressing questions: “How to define the value of a health outcome; how to capture it? Check out san diego boudoir photographer. In which areas of intervention is the value-based healthcare approach feasible; where would it be desirable? To what extent will value-based healthcare create new opportunities and accelerate innovation?”

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To guarantee our users happiness when working with our software, we are welcoming a brand-new quality specialist at Lyfegen: Liubov Buzila has joined the team and will keep an eagle eye on our platform to ensure everything runs like clockwork.

We sat down with Liubov to learn about her experience, her goals and her aspirations.

Hello Liubov, and welcome to Lyfegen! Please tell us a little about yourself: Where are you from, and what’s your educational and professional background?

I’m Ukrainian, but I moved to Romania two years ago and currently live in the city of Iași. I have a bachelor’s degree in applied linguistic, and my first job as a QA engineer was five years ago during my fourth year at university. I have worked in this field ever since.

What excites you about being a QA engineer?

Being a QA engineer is always challenging, and that’s what I love about it. Every day I deal with a lot of things that force me to think outside of the box. A tester is not only a person who has to find problems in the system, but also a person who takes responsibility for the system’s quality; this is what makes me super excited about my work – I enjoy improving our software for the better.

Why did you decide to join Lyfegen?

I am always striving to learn something new, and Lyfegen’s startup spirit is a great fit for that. I have tested products in different fields, but I have never worked in the healthcare industry before. Personally, I think it’s a great opportunity to see how the system works from a new perspective and to gain new experience.

What is something you want to learn or improve this year?

QA is a field where you are constantly learning something new, starting with technologies used in the product and ending by gaining new soft skills as part of an amazing team. The healthcare industry is new territory for me; I’m looking forward to exploring it and gaining expertise.

How will your know-how help to improve our customers’ experience of the Lyfegen platform?

My main goal is to improve the quality of the Lyfegen platform and deliver a highly reliable and convenient product to our customers. The rule is very simple: less bugs, happier customers!

Let’s get personal: What are your favorite things to do in your free time?

I love to cook! Whenever I get any free time, I find new recipes and try to impress my family. I also like listening to music. Music is the thing that helps me to relax and forget about my troubles. And, of course, I like travelling – I have been to 20 countries already, and I look forward to exploring more.

Is there anything else you are looking forward to outside of work this year?

Nothing specific, just enjoying my free time and travelling.

We are happy to have you with us, Liubov!

MEET THE LYFEGEN TEAM

Last week Lyfegen announced exciting news! Out of hundreds of start-ups, Lyfegen is among the top 10 selected to join one of Europe’s most innovative acceleration programs: InnoPeaks by Groupe Mutuel.

The news is taken with much excitement by Lyfegen’s co-founder, Michel Mohler, who briefly explains why being selected for this three month program by one of Switzerland’s leading health insurance companies is a great achievement for Lyfegen.

Hi Michel, can you give us a little more insights on the InnoPeaks program?

InnoPeaks is a business-focused acceleration program that focuses on challenging, enabling, growing, and scaling a business through workshops, mentorship, networking, and implementing proof of concepts. Groupe Mutuel, one of Switzerland’s leading health insurances, organizes this program. Their specific goal is to drive innovation in the two topics which support their core business: healthtech and insuretech.

Lyfegen is amongst only 10 startups that have been selected out of hundreds. What is Groupe Mutuel’s interest in having you on board?

Lyfegen, being one of Switzerland’s most innovative start-ups, is solving a crucial challenge healthcare – improving health outcomes for patients. We do this with our ground-breaking technology, working together with health insurances to give patients faster access to the medicine they need. Considering high-cost, personalized and potentially curative drugs, the prices of drugs need to become dynamic and depend on how well they work for patients. This also known as value-based contracting. Until recently, we have seen mostly Pharma Companies advocating for such pricing models. Engaging with a leading health insurance with our platform, we will achieve to bring such models to life in Switzerland, for Swiss patients.

What does Lyfegen want to achieve by being part of this program?

Switzerland's Federal Council (“Bundesrat”) addresses value-based contracting as one of the key solutions to achieve a more sustainable Swiss healthcare system. Our goal is to speak and learn from other startups, talk to decision makers at Groupe Mutuel, exchange thoughts and inspire Groupe Mutuel. As a result, we want to understand the perspective of health insurances and engage in a proof of concept.

We look forward to evolving with InnoPeaks, Groupe Mutuel and the other Start-ups. The team will be live-covering the InnoPeaks accelerator program in October, so stay tuned for more!

READ MORE ABOUT INNOPEAKS

At Lyfegen, we live by the highest quality standards, continuously improving as we move forward with facilitating value-based healthcare agreements for a fast & sustainable access to innovative therapies.

What is ISO 9001:2015?

The ISO 9001:2015 standard provides guidance and tools for companies and organizations who want to ensure that their products and services consistently meet customer’s requirements with quality being consistently improved.

This standard sets out the criteria for a quality management system used by many organization, large and small. Using ISO 9001:2015 helps ensure that customers get consistent, high quality products and services.

What this mean for Lyfegen?

At Lyfegen, we live by the highest quality standards, continuously improving our solutions & processes, as we move forward with the operationalisation of value-& data driven contracts for a fast & sustainable access to innovative therapies. In turn, this will benefit patients worldwide!

We are audited yearly by a third-party to keep our ISO status up to date.

Want to discover our solutions?

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“I am responsible for building the right products, and for building the products right.” Says Antti Hietala. Welcome to the Lyfegen Team!

As we embark on a new year, the great news start rolling in: Lyfegen welcomes its newest star, Antti Hietala, who takes on the key role of Product Owner.

As Antti arrives for his first day, Lyfegen’s CEO Girisha Fernando gives us his thoughts:
“Antti's excellent skills to think ahead and pull together industry, customer and technical perspectives to building a solid and ever-evolving product roadmap fills me with excitement, and will strengthen Lyfegen’s value for our customers even further. We are delighted to welcome Antti, a proud family man with values aligned with Lyfegen's values.”

We sat down with the ski-loving Product Owner to get a little more insight to who he is and what he will be doing at Lyfegen.

Hi Antti, tell us a little about yourself: where are you from and what is your professional background?

I come from the Arctic Circle. I grew up under the northern lights in a small town in northern Finland. I studied linguistics and computer science. My passion for content and technology led me to a career in technical writing. I wrote documentation for newspaper advertising systems and for financial asset management software.
Prior to joining Lyfegen I was the lead Product Manager at Magnolia where I built a content management solution. I’m a certified Scrum Product Owner and have worked with Product Managers and user experience designers in the past.

Why did you decide to join Lyfegen?

Lyfegen is my first venture into healthcare technology and it has an important mission: helping patients access innovative therapies by driving value-based healthcare. Removing obstacles that keep patients from getting the treatment or drugs they need is a high-level motivator. I’m also optimistic in our ability to make a big difference in the user experience of health technology and software.
I wanted to apply my product owner skills to an industry that is completely different from where I have worked before. Some say that it’s good to step out of your comfort zone and learn something completely new. The healthcare field is an exciting new challenge for me. I am thankful to the Lyfegen team for their confidence and trust that solid product management skills are universal and that I will apply them for a meaningful purpose.

You are joining Lyfegen as a Product Owner! In simple terms: what will you be working on?

I’m excited about joining Lyfegen! The team is packed with motivated and genuinely passionate people. We are on a path to build the most innovative contracting platform in the healthcare industry.
As Product Owner (PO) I am responsible for building the right products, and for building the products right. Concretely, this means talking to customers to understand their needs. I will define the product together with the Lyfegen team, translate the customer needs into features in our platform, together with our tech team.
My role has a strong outward-facing component. It’s critical for me to be in close contact with customers in order validate decisions quickly and build the right thing. My goal is to make our software valuable for our customers.

What are your next personal goals with Lyfegen?

Learning more about the healthcare and pharmaceutical industry is my first personal goal. There are so many new terms and abbreviations coming my way every day. It’s like the field has a language of its own.
On the product side, I’m very focused on optimizing the product-market fit. This means, finding the key features that really fulfill user needs and then amplifying those features in the product. I want to see users become fans! That’s a sign of a great product-market fit to me.

Enough about work! What passions do you have outside of Lyfegen?

I love to ski in the winter. I’m lucky to live in beautiful Switzerland where the Alps provide ample opportunity to hit the slopes. In the summer I do fly fishing in the Black Forest region of southern Germany or in Alsace, France. I’m also an avid pizza chef, forever improving my home-pizza game with the ultimate goal of authentic Neapolitan pie.

We are proud to welcome Antti to the Lyfegen team!

MEET THE LYFEGEN TEAM