Amanda Borodaty’s Post

The first edition of our 𝗤𝘂𝗮𝗿𝘁𝗲𝗿𝗹𝘆 𝗧𝗿𝗲𝗻𝗱𝘀 𝗥𝗲𝗽𝗼𝗿𝘁 is now available 🚀 At Lyfegen, we’ve reviewed over 𝟱,𝟬𝟬𝟬 𝗽𝘂𝗯𝗹𝗶𝗰 𝗮𝗴𝗿𝗲𝗲𝗺𝗲𝗻𝘁𝘀 to bring you a comprehensive analysis of the latest trends in drug access and pricing across 𝗔𝘀𝗶𝗮 𝗮𝗻𝗱 𝗘𝘂𝗿𝗼𝗽𝗲. This report offers a closer look at the evolution of 𝘃𝗮𝗹𝘂𝗲-𝗯𝗮𝘀𝗲𝗱 𝗮𝗴𝗿𝗲𝗲𝗺𝗲𝗻𝘁𝘀, with specific insights into areas like 𝗔𝗹𝘇𝗵𝗲𝗶𝗺𝗲𝗿’𝘀, 𝗖𝘆𝘀𝘁𝗶𝗰 𝗙𝗶𝗯𝗿𝗼𝘀𝗶𝘀, 𝗮𝗻𝗱 𝗲𝗺𝗲𝗿𝗴𝗶𝗻𝗴 𝗽𝗿𝗶𝗰𝗶𝗻𝗴 𝗺𝗼𝗱𝗲𝗹𝘀. Key highlights: • 𝗜𝗻-𝗱𝗲𝗽𝘁𝗵 𝗮𝗻𝗮𝗹𝘆𝘀𝗶𝘀 𝗼𝗳 𝗱𝗿𝘂𝗴 𝗿𝗲𝗶𝗺𝗯𝘂𝗿𝘀𝗲𝗺𝗲𝗻𝘁 in 𝗖𝗵𝗶𝗻𝗮, 𝗝𝗮𝗽𝗮𝗻, 𝗮𝗻𝗱 𝗦𝗼𝘂𝘁𝗵 𝗞𝗼𝗿𝗲𝗮, plus opportunities within commercial health insurance. • A detailed look at 𝗽𝗿𝗶𝗰𝗶𝗻𝗴 𝗺𝗼𝗱𝗲𝗹𝘀 in G𝗲𝗿𝗺𝗮𝗻𝘆, 𝗦𝗽𝗮𝗶𝗻, 𝗮𝗻𝗱 𝗣𝗼𝗿𝘁𝘂𝗴𝗮𝗹, focusing on innovative approaches to drug evaluations and pricing. • 𝗘𝗺𝗲𝗿𝗴𝗶𝗻𝗴 𝘁𝗿𝗲𝗻𝗱𝘀 such as outcome guarantees, restricted coverage, and price-volume agreements, all aimed at improving patient care. • Spotlight on agreements related to 𝗔𝗹𝘇𝗵𝗲𝗶𝗺𝗲𝗿’𝘀, 𝗗𝗲𝗺𝗲𝗻𝘁𝗶𝗮, 𝗮𝗻𝗱 𝗖𝘆𝘀𝘁𝗶𝗰 𝗙𝗶𝗯𝗿𝗼𝘀𝗶𝘀, with a focus on evolving reimbursement models. Our report offers valuable insights for health insurers, payers, and pharmaceutical companies, helping you stay informed and ahead of the curve. 𝗗𝗼𝘄𝗻𝗹𝗼𝗮𝗱 𝘆𝗼𝘂𝗿 𝗰𝗼𝗽𝘆 𝗵𝗲𝗿𝗲: https://hubs.la/Q02QyVb80 #HealthcareTrends #DrugPricing #ValueBasedContracts #Alzheimers #CysticFibrosis #PharmaAgreements #ReimbursementModels #GlobalHealthcare #HealthAccess #Lyfegen #TrendsReport #QuarterlyReport #IndustryInsights #HealthData #PharmaTrends #MarketAnalysis #DrugAccess

Dose of uncertainty: Drug industry warns pharmacare bill could upend economic balance https://ow.ly/3zWr50Tuq8i Sometimes getting to “DONE” is as simple as coffee & conversation. How about we have a chat… #groupbenefits #employeebenefits #consulting #leadership #communication #culture #compensation #wellness #employeeengagement #cgib Humans serving Humans

At Desjardins Insurance, we firmly believe in the benefits of biosimilars. That's why we've adopted a biosimilar strategy since 2016. 💊💉⚕️ “We’ve been working with our plan sponsors to maximize biosimilar value. Not only were we giving them peace of mind, but we were also considering the [sustainability] of their drug plan." This quote is from my colleague, Neda Nasseri, MSc. PharmD, MBA, who knows a thing or two about biosimilars (she’s a pharmacist!). Find out more about biosimilars and how they can benefit plan sponsors in this terrific article in Benefits Canada 👇 #DesjardinsInsurance #GroupInsurance #Biosimilars

Dose of uncertainty: Drug industry warns pharmacare bill could upend economic balance https://ow.ly/RMuW50Tuq8j Sometimes getting to “DONE” is as simple as coffee & conversation. How about we have a chat… #groupbenefits #employeebenefits #consulting #leadership #communication #culture #compensation #wellness #employeeengagement #cgib Humans serving Humans

We recently sat down with Insurance Business America to share our insights into the increasing cost of specialty drugs and its impacts on payers and risk managers. Our senior sales associates, Mike Gold and James Hughes, discuss how predictive analytics can be a solution to this rising industry problem. “Predictive analytics not only allows us to price for the known risks, but by virtue of looking at quantitative and qualitative data surrounding each person within a population, we are able to predict that risk with our emerging flags.” ➡ Read the full article here: https://lnkd.in/g-bhBahk

Early planning regarding reimbursement strategies for new therapies, particularly orphan drugs can both enhance market access and foster a more cohesive and effective ecosystem for all stakeholders involved. Innovative, market-ready solutions that prioritize patient outcomes while aligning the interests of insurers, employers, and manufacturers to potentially completely alter the landscape of healthcare coverage for rare diseases can be made possible by this proactive approach. The earlier, the better when it comes to engagement. #MarketAccess #OrphanDrugs #Healthcare

🩺 𝐏𝐚𝐭𝐢𝐞𝐧𝐭-𝐋𝐞𝐯𝐞𝐥 𝐒𝐚𝐯𝐢𝐧𝐠𝐬 𝐨𝐧 𝐆𝐞𝐧𝐞𝐫𝐢𝐜 𝐃𝐫𝐮𝐠𝐬 𝐓𝐡𝐫𝐨𝐮𝐠𝐡 Mark Cuban Cost Plus Drug Company, PBC 🩺 A recent study titled "𝑷𝒂𝒕𝒊𝒆𝒏𝒕-𝑳𝒆𝒗𝒆𝒍 𝑺𝒂𝒗𝒊𝒏𝒈𝒔 𝒐𝒏 𝑮𝒆𝒏𝒆𝒓𝒊𝒄 𝑫𝒓𝒖𝒈𝒔 𝑻𝒉𝒓𝒐𝒖𝒈𝒉 𝒕𝒉𝒆 𝑴𝒂𝒓𝒌 𝑪𝒖𝒃𝒂𝒏 𝑪𝒐𝒔𝒕 𝑷𝒍𝒖𝒔 𝑫𝒓𝒖𝒈 𝑪𝒐𝒎𝒑𝒂𝒏𝒚" published in JAMA Health Forum evaluates the potential out-of-pocket savings for patients purchasing generic drugs through MCCPDC’s transparent, direct-to-consumer online pharmacy. 🔸 𝐊𝐞𝐲 𝐅𝐢𝐧𝐝𝐢𝐧𝐠𝐬: 🔷 𝐂𝐨𝐬𝐭 𝐒𝐚𝐯𝐢𝐧𝐠𝐬: The study identified potential out-of-pocket cost savings for 11.8% of filled prescriptions among 124 generic drugs analyzed. The greatest savings were observed among uninsured patients. 🔷 𝐒𝐚𝐯𝐢𝐧𝐠𝐬 𝐛𝐲 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 𝐓𝐲𝐩𝐞: Cost savings varied by insurance type: uninsured (28.9%), military (9.9%), private (7.1%), and Medicare (5.5%). No savings were observed for Medicaid patients. 🔷 𝐌𝐞𝐝𝐢𝐚𝐧 𝐒𝐚𝐯𝐢𝐧𝐠𝐬: The median cost savings per prescription were highest for uninsured individuals ($6.08), followed by military ($5.05), Medicare ($4.64), and private insurance ($3.69). 🔸 𝐈𝐦𝐩𝐚𝐜𝐭 𝐨𝐧 𝐇𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐂𝐨𝐬𝐭𝐬: This study highlights the potential benefits of transparent cost-plus pharmacy pricing models in reducing out-of-pocket costs for specific patient subsets. While MCCPDC offers significant savings for some patients, the majority may still find it more cost-effective to use their health insurance benefits. Promoting such models can enhance accessibility and affordability of essential medications. 🔗 𝐑𝐞𝐚𝐝 𝐭𝐡𝐞 𝐟𝐮𝐥𝐥 𝐩𝐚𝐩𝐞𝐫: https://lnkd.in/gNH_6ySH #Pharmaceuticals #HealthcareSavings #GenericDrugs #PatientCare #CostSavings ♻️ 𝐑𝐞𝐩𝐨𝐬𝐭 𝐭𝐡𝐢𝐬 𝐢𝐟 𝐲𝐨𝐮 𝐟𝐨𝐮𝐧𝐝 𝐢𝐭 𝐢𝐧𝐬𝐢𝐠𝐡𝐭𝐟𝐮𝐥. ♻️ 🌐 𝐒𝐰𝐞𝐧𝐬𝐨𝐧 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐀𝐝𝐯𝐢𝐬𝐨𝐫𝐬 (𝐒𝐏𝐀) 𝐖𝐞𝐛𝐬𝐢𝐭𝐞: https://lnkd.in/gWFbVAjz

We hope our dive into "who pays for pharmaceuticals?" helps reduce the opacity of US healthcare (at least a little!). Click on the post below to learn more. Like and follow our page below to see the invisible economics of US healthcare.

Who truly pays for pharmaceuticals in the US? The answers might surprise you. Traditionally, Pharmacy Benefit Managers (PBMs) and health insurance plans are identified as the "payers" in the US. However, a deeper analysis in the "Follow the Dollar" report unveils a different reality. For many branded drugs, health plans typically cover only about one-third of the total cost, with PBMs seldom shouldering the financial burden. This analysis deconstructs dozens of pharmacy transaction line items, eliminating the complexities of various fees imposed by the #PBM on different stakeholders. Note that PBMs do not directly contribute to the cost but negotiate rebates and retain a portion for their services. For instance, in this example transaction, the PBM retained $10.65 while passing most of the rebate to the health plan or plan sponsor. 𝗧𝗵𝗲 𝗺𝗮𝗻𝘂𝗳𝗮𝗰𝘁𝘂𝗿𝗲𝗿 𝗶𝘀 𝘁𝗵𝗲 𝗼𝗻𝗹𝘆 𝘀𝘁𝗮𝗸𝗲𝗵𝗼𝗹𝗱𝗲𝗿 𝘄𝗵𝗼 𝗲𝗮𝗿𝗻𝘀 𝗺𝗼𝗿𝗲 𝗼𝗻 𝘁𝗵𝗶𝘀 𝘁𝗿𝗮𝗻𝘀𝗮𝗰𝘁𝗶𝗼𝗻 𝘁𝗵𝗮𝗻 𝘁𝗵𝗲 𝗣𝗕𝗠 (𝘀𝗼𝗿𝗿𝘆 #𝗽𝗵𝗮𝗿𝗺𝗮𝗰𝘆 𝗮𝗻𝗱 #𝘄𝗵𝗼𝗹𝗲𝘀𝗮𝗹𝗲𝗿 𝗽𝗮𝗿𝘁𝗻𝗲𝗿𝘀). Seeing through the opacity of US healthcare requires a deeper dive. Follow our page to learn more or explore our courses at invisibleeconomics.com #healthcare #pharmaceuticals #transparency #marketaccess #USmarketaccess #invisibleeconomics #pharma #pharmaceutical