In May, IHS Life Sciences traveled to Tokyo and Shanghai to bring its popular half-day breakfast briefing series to Asia for the first time. With pharmaceutical executives riveted by major upheavals in the drug pricing and reimbursement landscape in Japan and China, the well-attended sessions made for lively discussions.

Most of the questions swirled around similar themes: How much of a say will pharma companies get during Japan’s piloting of Health Technology Assessment? Are HTA criteria going to factor into the reimbursement of new drugs, and how soon will that day come? What does China’s new drug bioequivalence regulations mean, and what’s going to happen to the global pharma industry if Trump (or Hilary) wins the US elections?

Each briefing kicked off with a presentation of IHS’ Market Access Risk Rating Framework – a highly nuanced system which analyses quantitative and qualitative factors to produce a comprehensive evaluation of pharmaceutical market access risk around the world. Market risk is rated from 1 (very low) to 5 (very high).

In JAPAN (current risk rating: 2.62 and rising), the much-anticipated Health Technology Assessment (HTA) trials were high on everyone’s agenda. Last month, Japan’s Chuikyo announced that seven innovative hepatisis C drugs (including Gilead Sciences’ Sovaldi) would undergo a cost-effectiveness review, with re-pricing expected in 2018. Chief among pharmaceutical executives’ concerns: Will new drugs be next in line for cost-effectiveness review?

At the HTAi conference in Tokyo later that week, the same refrain echoed in the main conference hall, where Ministry of Health officials gave a run-down of the expansion of HTA in Japan.

After the speech was over and a slightly fraught silence remained, one executive strode up to the microphone to ask a question.

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“It has been announced that from October this year, companies will be required to submit cost-effectiveness data with reimbursement requests,” he said.

“Is it that you didn’t want to mention this, or that you just forgot?” he asked in (mock) exasperation.

How much influence will pharma companies have over the drug price negotiations? Another executive wanted to know.

“Companies can attend meetings of the special organisation for cost-effectiveness and can express views at the meeting,” came the reply. Whether that would give sponsor companies any real influence over pricing negotiations was hard to gauge.

The mood at IHS’ Shanghai breakfast briefing was similarly cautious.

Major topics of discussion included China’s ongoing drug price negotiations, which aim to slash the prices of several innovative treatments, including GlaxoSmithKline’s hepatitis B drug Viread and AstraZeneca‘s lung cancer drug Iressa. The briefing allowed for valuable discussion on the implications of the negotiations, ahead of the formal government announcement on May 20. The range of attendees – from pharma to insurance to R&D – made for interesting debate from a variety of angles.

Perhaps the most revealing insight came when conversing casually with executives during our three-day visit to Shanghai. One subject which came up often was China’s public hospital reform. During one conversation, a healthcare executive said, “Hospitals are having a pretty tough time these days, ever since the government stopped them from making revenue off pharmaceuticals.”

“Too true,” replied another. “Name me a single public hospital you know that’s making money.” No one could think of one.

“Never mind that, try making any money working as a doctor at a public hospital in China,” the first person said, grinning.

“I thought doctors now had more flexibility to work at other hospitals so they could earn more?” I asked.

“Yes, that’s definitely true,” he said. “But it never took off.”

Switching to Mandarin, he continued: “You know what happens? Say the public hospital doctor wants to work elsewhere part-time, to supplement his salary. But then guess what – suddenly his boss tells him that there happens to be an extra meeting on Friday. At 6pm.”

“Then, there’ll be another unexpected meeting on Saturday. And all through the weekend – random extra meetings. And so on. They never give him the chance to do his other job,” he said wryly.

Which goes to show that sometimes, the most interesting insights come during casual conversations, after the PowerPoints and microphones have been put away.

IHS Life Sciences plans to host more breakfast briefings across the world, to create similar opportunities to share insights on the pharmaceutical industry.