Changes Aim at Rebates, Pricing, and ACOs
I’m Ami Gopalan, Vice President, Director of Payer Access Solutions. Welcome back to All Access, Precision for Value’s bimonthly newsletter sharing the latest payer insights brought to you by our team of ex-payers.
In this edition, Todd Edgar examines the potential implications and impact of the Trump administration’s proposal to remove the safe harbor protection for rebates, Andrew Cournoyer takes a closer look at CMS’s efforts to rein in pricing, and Elizabeth Oyekan examines the impact of proposed changes to the MSSP program for ACOs.
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 payer team to address, and we’ll do our best to cover it in a future edition.
Regards,
Ami Gopalan
Ami Gopalan, PharmD, MBA
Vice President, Director,
Payer Access Solutions
EMAIL AMI
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.
Guest Editor
Ami Gopalan
Executive Editor
Louis Landon
Contributors
Elizabeth Oyekan
Todd Edgar
Ami Gopalan
Andrew Cournoyer
Jeremy Schafer
Louis Landon
Removal of Pharmaceutical Rebate Safe Harbor: Rough Waters Ahead?
The current administration is considering removing the safe harbor protection used to prevent drug rebates from being considered a kickback. While the details are still developing, such a move would likely have significant impacts on PBMs, manufacturers, and patients. Todd Edgar explores the possible ramifications.
Attacking Drug Prices and Targeting Medicare
Recent legislative actions by CMS have taken aim at the current Medicare structure, with negotiating leverage at the center of the initiatives. Arguably the primary target of these actions is the drug manufacturer. Andrew Cournoyer addresses the need for allied partnerships between payers and manufacturers as a way to navigate the increasingly complex landscape.
Pathway to Success: Proposed CMS Changes to the MSSP ACO Program and Their Implications
After 6 years, CMS is proposing changes to the MSSP, with ACOs set to take on additional risk in an effort to reduce the cost of care to the delivery system and Medicare beneficiaries. Precision’s Elizabeth Oyekan examines the proposed Pathway to Success rule and its central tenet, the adoption of 2-sided risk models.
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