Demand Copay Sensitivity Analysis RSV Vaccine

Project Objective

Our client had a late-stage vaccine candidate targeting older adult (OA) respiratory syncytial virus (RSV), and wanted support with its US pricing and access strategy; there were two main objectives:
- Provide P&MA insights and recommendations to support commercial and clinical development decisions for a RSV vaccine in older adults, specifically for Medicare Advantage plans (MAPD) and Part D plans (PDP)
- Understand patient cost sharing sensitivity for an adult RSV vaccine and assess the impact that various out-of-pocket cost scenarios would have on patient fulfillment in a Medicare population

First, we assessed the landscape and value proposition of the RSV vaccine to develop pricing and reimbursement hypotheses
Based off these hypotheses, we developed discussion materials and conducted 14 in-depth-individual interviews, including a mix of national / regional managed care organization (MCO) pharmacy and medical directors and pharmacy benefit managers (PBMs)
We captured payer value perceptions as well as price and management expectations across a number of different profile variations, including duration of protection and efficacy
Finally, we conducted quantitative primary research with a total of 249 patients over the age of 65 to assess how patient willingness to pay and demand would be affected by different out-of-pocket prices
- This data was used to optimize revenue from a payer management and cost sharing perspective

We analyzed the consumer demand data to determine levels of patient out-of-pocket costs by price and tier status, and assessed how this varied for MAPD vs PDP plans, identifying a specific list price maximum where MAPD out-of-pocket costs exceed PDP
Windrose also captured the impact that out-of-pocket costs have on OA patient fulfillment, across multiple profile variations to evaluate how different vaccine attributes impact likelihood of patient fulfillment
We developed key recommendations for our client’s pricing strategy to achieve broad ACIP recommendations across indication and the associated tier placement trade-offs
Finally, we integrated the consumer demand data with insights from the payer interviews to analyze the price-volume and price-revenue trade-offs at different prices (higher prices and lower patient fulfillment vs. lower prices and greater patient fulfillment) in order to inform our recommendations to maximize the commercial opportunity of the vaccine