Dr. Timos Papagatsias’ Post

Thoughts on this? >> IRA Will Shift Cost Burn to Part D Plans in 2025, Says Melissa Andel | AMCP 2024 - Managed Healthcare Executive >> Comment below! >>> lqventures.com #strategy #competitiveintelligence #marketing #pharma #healthcare #biotech #competitivemarketing #pharmaceutical

The IRA was introduced to lower the cost of prescription drugs purchased by Medicare. However, it had the unintended consequence of hurting biotech companies trying to bring new therapies to market. This is a concerning issue for the future of investment in R&D. Read more about why drug price controls pose a risk to the biotech industry: https://lnkd.in/gYvMqnrb

$6 billion here, $6 billion there TOP STORIESAdministration releases new Medicare drug prices The Biden administration released new prices for 10 high-cost drugs following Medicare's first-ever direct negotiations with pharmaceutical companies, a move that could have saved $6 billion last year. The prices, set to take effect in 2026, are part of the Inflation Reduction Act and aim to reduce costs for older adults and taxpayers.Full Story: The New York Times (8/15)      Expanded GLP-1 coverage could be costly for Medicare (Bloomberg/Getty Images) A study published in Health Affairs estimates that annual Medicare spending will increase between $3.1 billion and $6.1 billion if GLP-1 drugs gain expanded Medicare coverage for weight loss. GLP-1 drugs can cost more than $10,000 annually without insurance, and 10.9 million Medicare members with overweight or obesity would become eligible if the program covers them for weight loss. Full Story: Becker's Payer Issues (8/15)       

Employers, you don’t need to focus on cutting costs to ensure your drug plan is sustainable 💰 Instead focus on these 5 things and your plan’s sustainability will take care of itself. 1. Clinical benefits Make sure the drugs your plan members have access to provide clinically meaningful benefits in terms of survival and/or quality of life. When evaluating clinical benefits be sure to consider both efficacy and effectiveness. 2. Safety Consider evidence related to adverse effects. These include routine adverse effects expected with therapy as well as signals related to rare, serious adverse effects. 3. Cost-effectiveness Evaluate whether a drug represents value for money. Use cost-effectiveness analysis to determine whether the cost of a therapy is commensurate with the clinical benefit it provides. 4. Equity Systematically assess the equity implications of your drug reimbursement decisions. Aim to ensure every plan member has access to drugs that give them an excellent chance at treatment success. 5. Patient preferences Consider patients’ values and priorities related to drug therapies. Make patients partners in the decision-making process to ensure they have access to drugs that they consider acceptable and feasible to use. #pharmacybenefits #employeebenefits #healtheconomics If you found this post useful consider subscribing to my newsletter, Pharmacy Benefits Uncut: https://lnkd.in/gWN_2msD

As the Pharma #InflationReductionAct takes effect, #LifeScience majors remain unfazed by #CMS negotiated prices for the top 100 #MostExpensiveDrugs. Anticipation builds for the proposed #Sept announcements on #2026 list, aiming at over 25% price reduction. #Patients stand to #benefit, with room for improvement through #stakeholder #engagement, #feedback and enhanced #PricingFramework #transparency. https://lnkd.in/dkJhFySU

President Biden proposes a bold step: expanding Medicare's power to negotiate drug prices for up to 50 medications yearly, aiming to make healthcare more affordable for Americans. Will the result be as intended or will it simply mean more centralized government control of healthcare and stifling of innovation? Highlights include - 🔹 A proposed $2,000 cap on out-of-pocket expenses. 🔹 A $2 limit for high-value generics. 🔹 Tougher rebates for price hikes. As we navigate the implications, key questions remain: 🔹 How will this affect access and innovation in pharmaceuticals? 🔹 Can we balance affordability with the drive for new medicines? #HealthcareReform #DrugPricing #Medicare #Innovation

Something that has bothered me for a while in US healthcare: Why do we reimburse anything based on the % of the product price? --- There are many ways to reimburse healthcare services, including fee-schedule pricing, bundled payments, value-based reimbursement, and capitation. Most of the money right now in #USHealthcare is paid as a percent discount off product cost and may include an additional cost for administration/dispensing. Which is fine. Many other countries also use this method and have good outcomes with decent reimbursement to providers. Something I don't understand (from a value/payer perspective) is tying the reimbursement to the #DrugPrices --- The first example that comes to mind is infusion. Infusion providers absolutely deserve reimbursement for administering a drug. It's a valuable clinical skill. But the skill/effort/time required for a $10,000 brand drug isn't any different than the skill/effort/time required for the $5,000 biosimilar. Why should reimbursement be $300 more for the brand drug? Or tied to the price of the drug at all? ($10,000 x 6% = $600 vs $5,000 x 6% = $300) In my opinion, this misaligns incentives. Similar incentives appear throughout #pharmacy in the US. --- Part of business is knowing what providing the service costs. If the infusion center calculates $400 for administration of a drug to cover all of their costs and make a good profit, then why isn't that the transparent price being paid through a FFS or value-based care contract? You can see an example of the transparency I mean in the image attached from Blueberry Pharmacy --- While I like a lot of what Mark Cuban Cost Plus Drug Company, PBC is doing, this is one criticism I have--the 15% profit margin is tied to the cost of the drug. Most of their available drugs right now are cheap generic drugs, but the potential for misaligned incentives are still there for the future in the event more expensive drugs are dispensed. --- I'd like to hear what others think about this topic and the incentives it creates. Especially if you have a different perspective!

Employers, you don’t need to focus on cutting costs to ensure your drug plan is sustainable 💰 Instead focus on these 5 things and your plan’s sustainability will take care of itself. 1. Clinical benefits Make sure the drugs your plan members have access to provide clinically meaningful benefits in terms of survival and/or quality of life. When evaluating clinical benefits be sure to consider both efficacy and effectiveness. 2. Safety Consider evidence related to adverse effects. These include routine adverse effects expected with therapy as well as signals related to rare, serious adverse effects. 3. Cost-effectiveness Evaluate whether a drug represents value for money. Use cost-effectiveness analysis to determine whether the cost of a therapy is commensurate with the clinical benefit it provides. 4. Equity Systematically assess the equity implications of your drug reimbursement decisions. Ensure every plan member has access to drugs that give them an excellent chance at treatment success. 5. Patient preferences Consider patients’ values and priorities related to drug therapies. Make patients partners in the decision-making process to ensure they have access to drugs that they consider acceptable and feasible to use. #employeebenefits #pharmacybenefits #healtheconomics

Lowering Drug Prices for Better Healthcare: A Step Towards Affordable Treatments #accesstotreatments #healthcareaffordability #healthcarepolicy #healthcarereform #internationalpricingindex #Medicaredrugpricenegotiation #MedicarePartB #pharmaceuticalindustry #physicianadministereddrugs #risingdrugprices

“…the purpose of value-based pricing is not to reduce drug prices as much as possible. Instead, the main goal should be getting to the ‘right’ price. Paying too high a price diverts resources from better use elsewhere. Paying too little fails to send industry suitable signals to incentivize the development of new drugs…As drug prices have steadily risen, payers, clinicians and patients have lacked reliable information to allow comparisons of the benefits with the costs.” Peter Neumann Joshua Cohen Dan Ollendorf