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Population Health Learning Network
First Report Managed Care Insights from Asembia 2024: Matt Dickinson, PharmD, MBA, Alnylam Pharmaceuticals, led a panel to highlight payer strategies for managing rare and specialty disease products and how they continue to evolve based on Alnylam Pharmaceuticals’ 2023 Rare & Specialty Trend Report. While the report covers changes and consistencies among trends year-over-year, Dr Dickinson explained there were “new sections in this edition on employer involvement and benefit design, strategic finding, and 340B trends.” This article highlights key insights discussed during the panel. #FirstReportManagedCare #FRMC #RareandSpecialtyTrendReport #Asembia2024 #AsembiaInsights
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Wakely Consulting Group
On November 17, 2023, CMS released final program guidance to pharmaceutical manufacturers and Part D plan sponsors for implementing the Medicare Part D Manufacturer Discount Program for 2025 and 2026. This paper summarizes the key provisions of the MDP final guidance and other subsequent guidance, including a summary of programmatic differences and similarities to the previous Coverage Gap Discount Program (CGDP), an analysis of the impact of a phase-in of manufacturer discounts, and its potential implications to various stakeholders. Featured Authors: Jimmy Mans, David Walters, Sarah Legatt, #Wakely #Medicare #PartD #IRA #ManufacturerDiscountProgram
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COEUS
Takeda's CEO, Christophe Weber, recently published his annual letter. It addresses some key themes on which many biopharma CEOs are aligning: value-based care, price transparency, breaking up the middlemen, and driving healthcare access and equity. "For several years I have been outlining Takeda’s thinking on health equity—including advocating for a transition to value-based health care that pays for outcomes and care quality, emphasizing the need to prepare for the next pandemic by ensuring global vaccine equity and explaining how the protection of intellectual property rights is essential to incentivize investment in R&D. One area where we would like to see greater progress this year is pharmacy benefit managers reform. We support efforts in Congress to delink rebates from list prices or wholesale acquisition cost. It is a complex system, but the bottom line is that the current system creates misaligned incentives that ultimately result in higher costs for the system and higher out-of-pocket costs for patients. One potential way to address these challenges is through greater transparency. Transparency at the point of purchase for patients would empower them to make decisions knowing exactly what their costs will be. This could lower costs for the entire system by building greater pricing accountability along the chain so that no stakeholder can benefit from the inefficiencies resulting in the prices that patients pay today." At COEUS, we are working with the world's leading biopharma companies to help transition them from a broken FFS model towards value-based care. We built the world's leading platform that hosts the biggest CGT commercial launches, rapidly moving into Oncology, Obesity/Diabetes, and beyond. 1. Enabling Value-Based Healthcare: Our solution, COEBRA, provides a powerful tool for creating and managing contracts that pay for outcomes and care quality. 2. Enhancing Transparency: Our platform provides unprecedented transparency into the entire healthcare ecosystem by aggregating disparate healthcare data from various sources. This empowers payers, providers, and patients to make informed decisions and ties price and value to therapeutic outcomes. 3. Driving Innovation: Our platform's ability to evaluate complex rules for value-based contracts, real-world evidence studies, and health equity measurements fosters innovation in the pharmaceutical industry. By providing a tool to measure the impact of new solutions, we help companies drive medical advancements while ensuring equitable access. 4. Improving Access and Affordability: Our solution helps identify areas where access and affordability can be improved without compromising innovation. By providing data-driven insights into the effectiveness of various interventions, we enable stakeholders to make informed decisions that benefit patients and the healthcare system as a whole. Visit https://coebra.ai/. #vbc #obc #warranties #healthcare #pharma #CGT #oncology
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J R.
Healthtech investment 💰 is the force behind innovation 💡. Strategic funding can promote ethical tech use 📱 and even out healthcare disparities 🏥. Each dollar invested in healthtech shapes the future of healthcare 👩⚕️. Let's discuss how financial strategies impact healthtech. Thoughts below! 💭
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Maria Whitman
There’s an overwhelming amount health data out there, as we’ve discussed in ZS’s #FutureofHealth reports, but more is not necessarily better. We need better standards for how providers can and should use this data. This article offers examples of the work that needs to be done to make wearables actually helpful for patients, clinicians and researchers—and why we need to make sure all of these parties are at the table. https://lnkd.in/e7pjsy5f
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MedicineToMarket.com
Stories making headlines today in the biopharma industry: In a recent compilation of healthcare industry news: UnitedHealth Group's CEO, Andrew Witty, recently faced tough queries from Senators relating to the handling of a major cyber-attack, that eventually resulted in a $22 million payoff. The investigation primarily surrounds concerns about UnitedHealth's significant size and the impact of this recent security lapse, bringing the company's near-monopoly status into question. In other updates, Pfizer's first-quarter report suggests that their cost-cutting initiatives are nearly done, projecting a 'cautiously optimistic' future. The pharmaceutical giant seems to have tempered some audacious future forecasts and indicated that major acquisitions or mergers are not anticipated soon. Another intriguing development is Boehringer Ingelheim's recognition of AbbVie's Humira as a primary competitor for their Humira biosimilar Cyltezo – a recent addition to their product list following FDA approval. Boehringer aims to usurp Humira in PBM formularies to increase Cyltezo's market share. In legal news, Johnson & Johnson (J&J) and Bristol Myers Squibb have appealed against a ruling in a lawsuit keyed on the Inflation Reduction Act. Several pharmaceutical brands are racing against time to prevent new Medicare price negotiations expected in 2026. Senator Maggie Hassan (D-NH) has publicly reproached GlaxoSmithKline (GSK) for allegedly renegading on a prior commitment to cap inhaler prices at $35 monthly. This stems from GSK's discontinuation of a branded pediatric inhaler in favor of an authorized generic version that isn't subject to the said price cap. Lastly, J&J has suggested a $6.5 billion settlement plan aiming to address myriad lawsuits related to its talc products. With the controversy over alleged carcinogenic effects of its talc products, J&J's plan seeks to win approval from claimants before filing for Chapter 11. Stay tuned for more developments in the healthcare market. #pharma #biotech #topstories #biodatastudio
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Population Health Learning Network
First Report Managed Care Insights from Asembia 2024: Joe DePinto, Head of Cell, Gene, and Advanced Therapies at McKesson, discusses the evolution and challenges of payment models in the cell and gene therapy (CGT) space reviewed during his session at Asembia 2024. Learn how the value chain, cost density, complexity challenges, navigating the fragmented health care system, and exploring innovative payment models for access to groundbreaking drugs are all connected in the CGT landscape. #FirstReportManagedCare #FRMC #Asembia2024 #AsembiaInsights #CGT
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MMIT (Managed Markets Insight & Technology)
How are payers responding to the growth of competitive therapies in oncology? In this blog, MMIT’s Jory Fleischauer, Pharm.D. takes a look at the data on payer management approaches. Read now: https://ow.ly/gX1t50RlxVc #OncologyTherapies #CancerCare #PayerManagement #Oncology
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KLAS Research
The goal of one K2 payer/provider partnership was to increase medication adherence rates among patients with chronic conditions in an underserved patient community. What were some outcomes of their combined efforts? A. In the first year of the program, patients were 20 times more likely to fill their prescriptions B. High-risk patients better managed their conditions, so the organization saw fewer hospitalizations C. The healthcare organization was able to increase the payer’s Medication Adherence Tracker (MAT) score from a 3.3 to a 5.0 D. All of the above. Enter your answer in the comments! To learn more about the K2 Collaborative, click here: https://shorturl.at/mowH5 #K2Collaborative #PayerProviderCollaboration
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KLAS Research
The outcome of the combined payer/provider effort—highlighted in a Points of Light case study—was D, all of the above. To learn more about the K2 Collaborative, click here: https://lnkd.in/gqtHid_j Keep an eye on this space for the 2024 Points of Light Case Studies that will arrive early May. #K2Collaborative #PayerProviderCollaboration
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MMIT (Managed Markets Insight & Technology)
Payers are engaging specialty benefit management companies to help them manage high-cost, high-complexity disease states. In Fierce Pharma, MMIT’s Stephen Callahan shares the latest research and how this trend will impact pharma companies planning for market access: https://ow.ly/xUSr50SlgSl. #SpecialtyBenefitManagers #SBMs #PharmaCompanies #MarketAccess
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Kailash Concepts
The table below was featured in our recent piece, "The Case for Cardinal Health." ↓ https://lnkd.in/eeXEUtUj It shows the key financial metrics for the three largest drug wholesalers: Cardinal Health ($CAH), Cencora ($COR) & McKesson ($MCK). As you can see, despite operating very similar, highly profitable, relatively low-risk businesses, #CAH trades at sharp multiple discounts to both #COR & #MCK. Similarly, CAH trades at a 30%-50% lower Enterprise Value (EV)-to-Revenue multiple than its peers. If CAH were to be revalued such that its P/E multiple equaled those of its peers, CAH’s #stock price would be about $125, or 25% higher than it is today. Click the link below to subscribe to our newsletter ↓ https://lnkd.in/dC_jjzPp
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Digital Health Coalition
Come learn "The Art of Creating Practical Win-Win-Win Innovation for Patients, Providers, and Pharma" with three outstanding experts: Nandini Nayar, José Ma. Guido Avila, and Xander Kerman Gregory at the DHC Summit on June 25th. These three thoughtful leaders will share complimentary perspectives on leveraging emerging technology to change patients' lives, balanced with the real challenges of doing so in a regulated environment. It has never been more important for pharma to find practical innovations that drive business impact quickly. Join us at Amgen (Deerfield, IL) to discuss how to find the right opportunities to build positive-sum tools that work at scale. https://lnkd.in/evSXaYdx
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American College of Rheumatology
The average sales price of most biosimilars, which serves as the basis for CMS and private payer reimbursement, has fallen faster than the actual acquisition cost. The ACR has developed a fact sheet that discusses the importance of biologics to patient care, why adequate reimbursement for infusing them is important, and potential solutions to the problem of “underwater biosimilars.” View → https://acr.tw/3z45sMr
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