2019 Predictions: What Is to Come and How to Prepare
I’m Charline Shan, Vice President, Access Experience Team. Welcome back to All Access, Precision for Value’s bimonthly newsletter sharing the latest payer insights brought to you by our team of former access decision-makers.
Last year brought a flurry of unexpected changes. Depending on the stakeholder, some were good and some not so good. In this edition we encapsulate some of the most important changes on the horizon for 2019 and have asked our advisors to offer their predictions and impact for market access leaders. Jeremy Schafer reviews the growing number of gene therapies and how payers are in the midst of creating innovative and/or alternative payment methods to address the high cost of these therapies; Dominic Galante indicates payer and health system consolidation will continue to increase; Todd Edgar examines the proposed rule by HHS to amend the safe harbor regulations; Andy Cournoyer tackles two visions of Medicare policy changes and ICER’s growing influence; and Elizabeth Oyekan delivers an in-depth playbook of strategies that payers and health systems might employ to manage drug costs.
I think you’ll find the insights in All Access to be thought provoking and helpful in navigating the payer landscape. As always, please feel free to drop me a note and let me know if you have a topic suggestion for the Access Experience Team to address, and we’ll do our best to cover it in a future edition.
All Access is a bimonthly newsletter that features key insights from our team of former payers, intended specifically for market access leaders. It is published by Precision for Value.
Nearly 300 cell and gene therapies are currently in development. Though not all will make it through to approval, the gene/cell therapy revolution appears to be growing unabated. What big problems might this create for payers and our current healthcare system?
As consolidation increases, so too does payer and organized provider buying power. More than ever, biopharmaceutical manufacturers must demonstrate the economic and clinical value of their products. Take a closer look at some of the recent consolidations and how they might impact drug access, coverage, and reimbursement.
With the release of the HHS safe harbor proposal, more information is available than when only the title was public. Indeed, over the past few weeks, many articles have been published with detailed summaries of the proposal—yet, many questions remain. For All Access, Todd Edgar breaks down some of the most granular issues to consider and asks the question: How prepared is the market for a change of this magnitude?
Drug costs are a main concern for both government and commercial payers. In 2018, CMS tackled drug costs in Medicare through several measures. Will the trend continue in 2019? Meanwhile, the use of ICER’s value framework to inform commercial payer decision makers is increasing. Are value- and outcomes-based strategies more important?
Offensive or Defensive Drug Cost Strategies: Which Will Give Payers and Health Systems the Best Chance to Lower Drug Costs?
When it comes to winning in the effort to reduce rising drug costs, there are new offensive and defensive strategies in play. What works better in pharma? Does a good offense beat a good defense?