2023 Trends, Events, and Developments (TEDs) in the Payer World — focusing on Payer Spend and Utilization Management

Welcome to the Back To School issue! I am Cynthia Miller, MD, MPH, FACP, Vice President Medical Director – Access Experience Team, editor of All Access Newsletter. This edition will focus on the current and emerging drug utilization management trends occurring in various segments of the payer world to manage drug costs and spend.  Our expert ex-payers will provide insights into these trends and developments and how they foresee them impacting the healthcare system, especially patients, health systems, and the pharmaceutical industry.

Biosimilar Pricing Strategies
Molly Borchardt, PharmD–Senior Director, Access Experience Team
Molly discusses the complexity of pricing, contracting, and market share around the new adalimumab biosimilars, and the strategies payers will use to maximize the cost savings on the pharmacy benefit. She provides several suggestions for pharmaceutical companies that are entering the biosimilar space.

Potential Expansion of CMS’s Site-neutrality Payment Policy and Its Impact The Future of Prior Authorization and Reform
Jennifer Williams, PharmD, BCOP–VP, Access Experience Team 
Jennifer tackles the changing landscape of prior authorization from increased payer pressure to relieve provider and patient burden coupled with the rising payer spend on pharmaceuticals. She gives solutions for how pharmaceutical companies can handle the downstream consequences of prior authorization reform.

How the Enhancing Oncology Model and Inflation Reduction Act May Affect Price
Ryan M. Cox, RPh, MBA–VP, Director Access Experience Team
Ryan dives into the combined effects of the Enhanced Oncology Model (EOM) and the Inflation Reduction Act (IRA) on the healthcare market.  He discusses the potential unintended consequences for pharmaceutical companies.

As a surprise addition to this month’s All Access Newsletter, we have 2 videos that discuss the impact of the IRA!  First, Erin Lopata discusses how CMS negotiation may affect drug competition and how this may influence formulary design, patient demand, and commercial contracts. Second, Amy Martin shares her insights on how the IRA will impact biosimilars in terms of launch pricing, biosimilar development, and future innovation.

IRA Erin Part I & IRA Erin Part II

We believe you will find these drug utilization management TEDs and their impact on market access insightful as you navigate 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.

Best Regards,

Cynthia Miller
VP, Medical Director
Experience Team


All Access is a bimonthly newsletter featuring key insights from our team of former payers intended specifically for market access leaders. It is published by PRECISIONvalue.

Guest Editor
Cynthia Miller

Andrew Cournoyer
Ryan Cox
Dan Danielson
Todd Edgar
Jorge Font
Dominic Galante
Ami Gopalan
Maureen Hennessey
Barbara Henry
Joe Honcz
Sejal Jonas
Kris Kang
Erin Lopata
Amy Martin
Ray Roth
Janet Serluco
Charline Shan
Jennifer Williams