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 interview, Vibhu Tewary, project director, IQVIA Institute for Human Data Science, discusses:

Highlights of the company’s report surrounding the “Long-term Market Sustainability for Infused Biosimilars in the US: Foundational Analytics on Emerging Risks to Sustainability”

The process that constructing and piecing together a report of this magnitude entails, along with where the idea itself came from

The ongoing challenges surrounding ASP-based reimbursement

A closed-door, multi-stakeholder virtual roundtable (based on his original report) that was previously held

Vibhu Tewary offers insight on this market segment, including a behind-the-scenes of what goes into designing a report. 

The Path Forward for Infused Biosimilars in the US

 interview, Mark Bouck, chairman and CEO of PharmAlliance, a pharmaceutical and life sciences services platform, dives into:

How PharmAlliance’s acquisition of Complete Health Economics Outcomes Research Solutions (CHEORS) helps expand global reach

The platform’s biggest goal to when it comes to CHEORS and market access services

How CHEORS helps navigate cost-effectiveness and market access hurdles

Acquisitions in the space that are currently in the works

Mark Bouck discusses PharmAlliance’s latest acquisitions, while reiterating its goals surrounding health economics and outcomes research.

Navigating Market Access Hurdles

 interview, Brandon Newman, Xevant’s CEO and founder, explores:

The implications of the Inflation Reduction Act’s price negotiation provisions, and how these could result in ripple effects across the healthcare system

The role that pharmacy benefit managers (PBMs) and other intermediaries' play when it comes to determining drug costs, and how spread pricing is involved

How Xevant helps improve drug cost transparency efforts

Strategies for affordability Newman would offer the pharma industry that can be implemented immediately

Brandon Newman joins The Pharmaceutical Commerce Podcast to discuss the evolving role of PBMs, including the importance of drug price transparency. 

A Further Examination of Pharmacy Benefit Managers

A seminar shares key observations and learnings from the first round of direct price negotiations.

Asembia 2025: Understanding the Inflation Reduction Act

A session dives into the trends surrounding specialty drugs and therapies, along with providing an overview of the drug development landscape. 

Asembia 2025: The Specialty Pharma Pipeline

The interchangeability designation for Yuflyma, a biosimilar to Humira, may help to improve patient access and reduce costs. 

FDA Grants Interchangeability Designation to Celltrion’s Humira Biosimilar Yuflyma 

The key strategies for reducing or eliminating post-prescription abandonment.

From Prescription to Patient: Four Ways to Increase Speed to Therapy 

A look at the prevailing factors impacting treatment access in 2025.

Healthcare Scorecard from Patients with Chronic Illness

Therapy Advancements Highlight Growing Cost and Access Concerns

, Fran Gregory, VP, emerging therapies, Cardinal Health, shared key insights into the evolving landscape of cell and gene therapies. Speaking about the current state of the market, the anticipated growth of the pipeline, and the critical steps needed to ensure long-term sustainability, Gregory highlighted both the transformative potential of these therapies and the systemic challenges that must be addressed. Her perspective offered a comprehensive look at where the field stands today—and where it's heading next.

PC: You were a part of the ‘Cell, Gene and Beyond: What’s Working and Where Do We Go Next’ panel. Can you provide a brief synopsis of what the session entailed?

Our presentation provided a foundational overview of cell and gene therapy, including the current state of the market and where we believe the field is headed. We offered a pipeline snapshot, spotlighted several key products, and discussed what’s going well in the space. From there, we identified areas that require additional attention to ensure continued progress.

We've made significant strides over the past eight years since the first cell and gene therapy launch. This session was really about exploring the next wave of advancements necessary to propel the industry forward.

PC: What stands out to you most about the current state of the cell and gene therapy pipeline, and where is the momentum building right now?

The most striking aspect is how rapidly the field is evolving. The pipeline is incredibly promising in terms of patient impact—we anticipate over 100,000 patients could be treated with cell and gene therapies by 2030. However, there's also a significant financial burden. We're projecting $75 to $80 billion in healthcare system costs by that same year, which is approaching quickly.

While it’s inspiring to consider the lives that could be transformed by these therapies, we must also address affordability. That means advancing innovative payment models, implementing robust outcomes tracking, and refining health economics frameworks.

As for the pipeline itself, it's currently heavily concentrated in oncology and hematology, with many approved and in-development therapies in those areas. But what’s especially exciting is the emerging diversification—we’re beginning to see growth in other therapeutic categories like neurology, ophthalmology, rheumatology, and immunology. This broadening suggests the pipeline will continue to expand its impact across a wider range of diseases in the near future.

The session began with an overview of the cell and gene therapy (CGT) landscape—where the industry stands today and what the future may hold. The discussion included a pipeline review, highlighted key products, and identified both current successes and future areas of focus. Since the first CGT approval eight years ago, there has been significant progress. The conversation emphasized the need to continue advancing the field to ensure its momentum is sustained.

The CGT pipeline is rapidly evolving and holds tremendous promise, with projections estimating over 100,000 patients may benefit by 2030. However, this comes with a projected $75–80 billion cost to the healthcare system, prompting the need for sustainable payment models. Currently, around half of the pipeline targets oncology and hematology, but the field is expanding to include neurology, ophthalmology, rheumatology, and immunology, signaling broader therapeutic impact.

Patient outcomes from CGTs are transformative, yet there’s a growing need for long-term data to quantify their durability and cost-effectiveness. The discussion underscored the importance of robust health economic modeling and outcomes tracking to demonstrate value and guide reimbursement strategies. Insights from groups like ICER already point to the value of CGTs, but more evidence is required to solidify these claims.

Innovative payment models are crucial for long-term sustainability. The most promising models include outcomes-based contracts, where reimbursement aligns with patient response, and annuity payments, which spread costs over time. Models based on performance guarantees are less popular due to their all-or-nothing structure.

Looking ahead, the boldest move the industry can make is to collaboratively develop systems that ensure patient access while addressing affordability. Achieving this balance will require cooperation across stakeholders—payers, manufacturers, providers, and intermediaries—to ensure CGTs deliver on their full potential.

Fran Gregory, VP, emerging therapies, Cardinal Health, discusses the evolving cell and gene therapy landscape, highlighting pipeline growth, cost challenges, and emerging therapeutic areas beyond oncology and hematology.

Latest Conference Coverage

Asembia 2025: Therapy Advancements Highlight Growing Cost and Access Concerns

Bridging Health Gaps Through Equity and Education

As the healthcare industry sharpens its focus on patient-centered care, addressing social determinants of health, health equity, and literacy has become more critical than ever—particularly for individuals with chronic and rare conditions. During the 

"Speaking Health and Human: Bridging the Gap to Quality Patient Care"

 session, Tiara Green will join industry leaders to explore how barriers to access, education, and navigation of the healthcare system directly influence patient outcomes. In an interview with 

, Green previews the key issues shaping the conversation and why understanding these factors is essential to delivering better, more equitable care.

PC: You will be a part of the ‘Speaking Health and Human: Bridging the Gap to Quality Patient Care’ session. Can you provide a brief synopsis of what to expect during the discussion?

We definitely encourage people to attend the session, but broadly, we'll be exploring the impact of health equity on screening and diagnostic services, as well as the role of health literacy. We’ll discuss how these factors together influence overall health outcomes.

PC: How do you see social determinants of health shaping the patient experience, particularly for those with rare or chronic conditions?

Social determinants of health are critical for all patients, but they’re especially important for those living with rare or chronic conditions. We need to consider access to care—how income level, education, and where someone lives affect their ability to get the services they need.

For example, individuals in rural areas—or even in low-income urban communities—may struggle to access healthcare providers, especially specialists. When dealing with rare or chronic conditions, access to specialized care is vital, yet not always available or easy to navigate.

Health literacy also plays a key role. Individuals with lower educational attainment—such as not completing high school or college—may not fully understand how to navigate the healthcare system. Even as professionals, we sometimes find the system difficult to manage. That’s why it’s so important to address these barriers if we want to improve health outcomes.

During the “Health and Human: Bridging the Gap to Quality Patient Care” session, attendees can expect a thoughtful discussion on how health equity, screening and diagnostic services, and health literacy together influence overall healthcare outcomes. The session will explore how social determinants of health—such as income, education level, and geographic location—directly impact the patient experience, especially for individuals living with rare and chronic conditions. Challenges like limited access to specialized care, difficulty navigating complex healthcare systems, and lower levels of health literacy will be key themes.

The conversation will also highlight effective strategies that have successfully bridged gaps in healthcare access. One major focus will be the role of community health workers, who serve as trusted, relatable figures within their communities. By understanding and representing the populations they serve, these workers can connect individuals to essential screenings, care resources, and social services like employment or food assistance.

Another critical point will center on how healthcare providers and systems can better design preventive and educational interventions by involving community members early in the planning process. Rather than imposing pre-developed programs, incorporating the lived experiences and voices of the target population helps create initiatives that are more relevant, effective, and sustainable.

Finally, looking to the future, the speaker emphasizes that achieving a healthier, more equitable society requires systemic and structural change. Addressing issues at the policy and institutional levels, fostering collaboration between healthcare systems and community-based organizations, and rethinking how care is delivered will be essential to creating lasting improvements in health equity.

Tiara Green, president, Accessia Health, highlights key themes from the upcoming discussion on how health equity, literacy, and social determinants are reshaping patient care—especially for those with chronic and rare conditions.

Asembia 2025: Bridging Health Gaps Through Equity and Education

Where Does Healthcare Price Transparency Stand Today?

Turquoise Health’s SVP of market solutions

 describes how the recent executive order on healthcare price transparency aims to make pricing in the healthcare industry more accessible and understandable for patients. This initiative is a continuation of efforts by both the Trump and Biden administrations, with the goal of improving transparency around hospital and payer reimbursement rates. The central idea is to require all hospitals and insurance companies to publicly disclose their contractual reimbursement rates, meaning patients will have clearer insights into what insurers pay hospitals for services.

Historically, these prices were not transparent, making it difficult for patients to understand the actual costs of healthcare. While earlier laws introduced in 2019 improved pricing transparency, there have been enforcement challenges. The new executive order seeks to address these issues by ensuring hospitals and payers comply with transparency requirements. A key update in the order is the inclusion of prescription drug prices, which had previously been excluded from transparency rules.

The broader impact of this order is to make healthcare pricing as transparent and predictable as other consumer services, like booking a flight or a haircut. Although the system is not fully realized yet, this executive order lays the foundation for a future where patients can easily access upfront pricing before seeking healthcare services. This transparency is expected to simplify the decision-making process for patients, ultimately fostering a more informed and competitive healthcare environment.

O’Dell also comments on the biggest challenges healthcare organizations currently face in terms of price transparency; where the healthcare industry currently stand in terms of compliance with price transparency regulations; specific strategies Turquoise Health provides in order to help healthcare providers navigate and meet the new price transparency requirements; and much more.

Where does the healthcare industry currently stand in terms of compliance with price transparency regulations, and what steps need to be taken to achieve full compliance?

There's been a lot of evolution over the course of the last four years, so when these regulations came out, only 20% to 30% of hospitals were complying, and I really think they hoped this is going to go away. “We don't want to publish our rates. I hope this just falls by the wayside.” Lo and behold, the Biden administration comes in and starts enforcing it and says you actually have to publish your rates.

We saw a huge uptick in compliance over the course of the last four years, and now, 95-plus-percent of hospitals publish a machine-readable file. You'll see that sometimes called an MRF. What that means is that is just the standard format that they publish their rates in. Ninety percent of all payers also do the same thing. We see good compliance in that the files are out there. They're saying, “we've complied, here's the file.”

The area where I think there's room for improvement is what is in the actual file. We saw a huge improvement come in July of 2024, where hospitals had to start publishing their exact drug rates, the units of the drug, how they got reimbursed—they had to do it in a standard format, so the quality of the file improved immensely. Just because you have a file out there doesn't mean it's very useful. Over time, they've added new regulations to say we're going to enforce this and we're going to make it more standard. That's exactly, what this executive order is trying to do. It's saying we're going to enforce it, we're going to make it more standard. If you're one of those 5% that's not doing it, you're going to get a letter. If you're not doing it in the standard way that we published, you're going to get a letter. Perhaps most importantly, if you are a prescription drug payer or a prescription drug provider, it's time to start publishing your rates too. There's a term that I think is kind of a boring term when you say it, but will become very important to this, which is called historical net price. And that's what we don't have for drugs today, and that's what I think that the executive order is trying to bring out.

Historical net price just means, what is the actual price of the product after you give discounts and rebates? I won't try to explain it, but the drug value chain is incredibly complex. There're lots of middlemen, per se, and each middleman is taking a little bit of the drug price. They're saying, I'll take a little rebate, or I'll take a little discount along the way.

Historical net price is effectively just a complicated word to say, you set a sticker price on a drug, but what did it actually get bought for by the doctor's office who's going to put it into the patient? So that difference is historical net price, and what your historical net price is can be than what my historical net price is, so you might be getting a different contract discount rebate than I am, and that's still to this day, completely invisible. It’s very difficult to make prices public or to help a consumer understand what they're going to pay for something if we have no idea what the drug price is that the PBM, pharmacy, or payer are going to pay or get reimbursed for something.

In the third part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Chris O’Dell, provides an update on where the healthcare industry currently stands in terms of compliance with price transparency regulations, and what steps need to be taken to achieve full compliance.

The Complexity of Healthcare Price Transparency

What are the biggest challenges healthcare organizations currently face in terms of price transparency?

The biggest challenges I think healthcare organizations and payers face is just that the data that's required to be published is absolutely massive. The company I work for, Turquoise Health, is a price transparency company. We ingest a petabyte of data every single month, which is a massive amount of data to bring in. That means we're going out to 11,000 different sources and grabbing it from all the payers and all the hospitals, and trying to bring all that data in and standardize it. I think just the size is a very difficult part.

Perhaps even more important than that is the word that I just said, which is “standards.” In order for it to be useful, everyone's got to do it in the exact same way. It's kind of like, everyone's got to drive on the same railroad track size if you want the trains to be able to integrate and go across state lines. Same is true for these data flows. We're getting there, but we're not quite there yet, meaning that hospitals’ contracts are highly variable, so the way one hospital might contract for a service is very different, compared how the next one does. When they publish the data, now you have to find a way to make it apples to apples so that a consumer can compare. That is the absolute hardest part of price transparency—they can show you the price, but you as a consumer might not know what to make of that unless someone standardizes it.

In the second part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Chris O’Dell, Turquoise Health’s SVP of market solutions, discusses the biggest challenges healthcare organizations currently face in terms of price transparency.

Breaking Down the New Executive Order on Healthcare Price Transparency

Can you explain the key provisions of the recently released executive order on healthcare price transparency and how it will impact the healthcare industry?

These executive orders are about price transparency, and this is not a new concept for the Trump administration or for the Biden administration for that matter. This happens to be one of the few bipartisan things perhaps that's out there. In essence, what they want to do is make all hospitals and all payers make all of their contractual reimbursement rates public. Those are complicated terms if you're not in the industry, but it basically just means, what is your insurer, as a patient, pay to the hospital for the service that you received? As wild as this sounds, until these price transparency laws were out, none of that ever existed.

That was all a guessing game, and no one had any visibility into it. Over the course of the last four years, since the first version of these laws came out in 2019, we've seen a lot better prices, and we've seen a lot better data on these—what does the payer pay to the hospital?

Why are we talking today? Why does this new executive order even need to happen? It's because first they feel that the laws have not been enforced enough. They're saying, these are good laws, but we need to really make sure that hospitals and payers are doing this, and we're going to enforce it if they're not doing it. The second thing that comes through is drug prices. Hospitals and insurance companies had to make all their rates available, but somehow, the pharmacy benefit drugs, or prescription drugs—as they reference in this executive order—squeaked away and didn't have to comply with the regulations.

They're coming back and saying, we're going to enforce and we're going to make sure that drug prices are visible. What does this mean for the whole healthcare industry? I actually agree with what I think the government believes here, which is that it makes it easier for a patient to understand what they're going to pay for healthcare services before they go in. They use this term of “guaranteed upfront prices,” and that's their government speak for saying it's as easy to go get healthcare services and know what you're going to pay as it is to book a flight or go get a haircut or whatever example you want to use—that's what they're going for. We are not there yet, but these are the building blocks and foundation that they're using to get there.

In the first part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Chris O’Dell, Turquoise Health’s SVP of market solutions, outlines the key provisions of the recently released executive order on healthcare price transparency.

Specialty Medicine Onboarding

PC: How does Pleio’s GoodStart program assist specialty pharmacies in improving patient engagement and adherence?

Onboarding onto specialty medications is a complex and often overwhelming process for patients. That’s the core challenge Pleio addresses with our GoodStart program. We focus on delivering patient-centric support to specialty pharmacies through a comprehensive, wraparound solution. Our approach ensures that patients receive their medication, understand the process, and feel supported every step of the way.

A key part of our program is helping patients navigate the specialty pharmacy process—explaining what to expect, which teams will be involved, and what lies ahead. We create a judgment-free space where patients can take a breath, process their diagnosis, and feel reassured that someone is checking in on them.

Through GoodStart, our GoodStarters personally reach out to patients, welcoming them to the pharmacy. After they receive their prescription, we follow up to provide additional guidance—building their knowledge, skills, and ultimately, their confidence in managing their medication regimen. We also connect them with valuable resources they may not have previously known about.

The Good Start program by Pleio is designed to assist specialty pharmacies in improving patient engagement and adherence by providing comprehensive, patient-centric support. Specialty medications often involve complex onboarding processes, leaving patients feeling overwhelmed. Good Start addresses this by offering a structured, wraparound approach that guides patients from the moment they receive their medication. The program ensures patients understand the specialty pharmacy process, introduces them to their care teams, and creates a supportive environment that reduces anxiety.

A key feature of Good Start is its peer-to-patient outreach model, which addresses emotional barriers such as fear, mistrust, and anxiety—factors that significantly contribute to medication non-adherence. Non-clinical peers engage with patients in a more relatable manner, providing reassurance and helping them navigate the treatment process without the intimidation of clinical discussions. This approach aligns with findings from the AMA, which highlight that emotional barriers are a major cause of non-adherence.

Patient engagement in specialty pharmacy is evolving alongside technological advancements. While digital tools provide valuable resources, they can also be overwhelming. Patients expect more personalized support, including human check-ins that reinforce adherence. Pleio’s program has demonstrated success in improving key adherence metrics, including a 5% increase in proportion of days covered (PDC), an 80% rise in average scripts per patient, and a 60% boost in medication volume.

Jen Butler, chief commercial officer, Pleio, discusses how the company’s GoodStart programs help patients navigate specialty pharmacies. 

Hubs East 2025: Navigating Specialty Medication Onboarding

Unfinished Healthcare Reform

Charitable donations have long been a vital lifeline for patients struggling to afford life-saving medications, particularly those with chronic and rare diseases. Over the past few decades, various assistance programs—including nonprofit safety nets, third-party organizations, and manufacturer-sponsored free drug initiatives—have emerged to bridge the gap between medical advancements and patient affordability. However, despite these efforts, high out-of-pocket costs still prevent many individuals from accessing essential treatments. In an interview with 

, Jonathan James, CEO of Hope Charities, shares insights on reducing barriers to care and improving patient access.

PC: Are there emerging models of charitable giving or patient assistance that you believe could redefine financial access to care in the coming years?

Redefining access to care is a significant task—one that thousands of people have worked on in the United States for a long time. I believe there are numerous hurdles that need to be addressed. We've evaluated various policy changes that could meaningfully improve accessibility for people with these needs. However, achieving a laser-focused agreement remains challenging.

One piece of legislation that has brought significant change in recent years is the Inflation Reduction Act, which limited out-of-pocket expenses for people on Medicare. If you look at what we call the "Medicaid unwinding" that occurred after COVID—where people were once again required to continually prove eligibility—many individuals lost Medicaid coverage and were left in a vulnerable position. Today, millions of people in this country remain completely uninsured. Addressing these challenges requires overcoming several systemic barriers. The Affordable Care Act (ACA) was a game-changer in many ways, expanding access to commercial insurance, which was a positive development.

On the flip side, many people still don’t know how to navigate the system. They remain hesitant or uncertain, as the healthcare landscape has gone through multiple changes over time. In many states, we’ve seen that when people seek coverage through the marketplace, they initially had three to five plan options—some more competitive than when the ACA first launched. However, in certain ZIP codes, choices have since dwindled to just one plan, and that option is often expensive. Fortunately, subsidies have helped bridge some of the financial gap, but much more work is needed to ensure health insurance remains sustainable and accessible.

According to statistics from the Kaiser Family Foundation, while there is significant focus on high-cost medications, they actually account for only about 13% of total healthcare expenditures in the United States. The real financial burden lies in hospitalization and inpatient care, which make up over 50% of costs. As a result, while high-cost medications receive intense scrutiny, they represent a relatively small portion of overall spending. Meanwhile, hospitalization expenses require greater attention and cost-reduction efforts.

The system is complex in many ways, but if we can ensure people receive the care they need at home—such as timely access to the right prescriptions—the reliance on costly hospital visits would decrease. It's crucial that we continue providing robust financial assistance for individuals in critical care situations who require ongoing access to medications. Doing so will help prevent hospitalization costs from escalating even further.

 Charitable donations have played a crucial role in helping patients access life-saving medications, particularly those with chronic and rare diseases who face significant financial barriers. Over the past 25-30 years, various assistance programs—including nonprofit safety nets, third-party organizations, and manufacturer-sponsored free drug programs—have emerged to support patients struggling with the rising costs of healthcare. However, despite these efforts, many individuals still face challenges in affording their treatments, with high out-of-pocket costs often preventing them from receiving necessary care.

For conditions like hemophilia, where annual treatment costs can exceed $1 million, losing access to medication can mean a drastic decline in quality of life, forcing patients to rely on disability or face severe health complications. While charitable programs provide critical relief, they also struggle with sustainability due to funding shortages and limited public awareness. Many organizations must balance the need to educate patients about available assistance while ensuring they have enough resources to support those in need.

Healthcare policies such as the Inflation Reduction Act and Medicaid redeterminations have also influenced access to care, sometimes alleviating costs for certain populations while creating new challenges for others. While high-cost medications often receive the most scrutiny, hospitalization and inpatient care account for a much larger portion of healthcare spending. Expanding financial assistance for prescription medications could help reduce hospital admissions and lower overall healthcare costs.

Looking forward, there is a need for more sustainable models of charitable giving and financial aid to ensure that patients can consistently access the treatments they need. Policy reforms, expanded subsidies, and a greater focus on preventative care may help create a more equitable healthcare system while reducing the financial strain on both patients and assistance programs.

Jonathan James, CEO, Hope Charities, discusses how, despite policy advancements, millions of people still face barriers to healthcare access.

PAP 2025: The Unfinished Work of Healthcare Reform

How a Completely Open Generic Market Could Alter Rx Costs

, Geoffrey Joyce, PhD, director of health policy at the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California (USC, describes how the 10% tax on Chinese goods and a potential 25% tariff on pharmaceuticals could have notable effects on the price, quality, and safety of generic drugs. He explains that while branded and generic drug markets operate differently, the cost of generics is typically much lower, with intense competition driving prices down. A 10% tariff on generics might not significantly impact costs because most of the price is tied to distribution, not manufacturing. However, the COVID-19 pandemic highlighted the risks of relying on countries like China and India for essential generics, which has led to a push to bring production back to the U.S.

A 25% tariff would likely make domestic production more attractive, but generics are low-margin products, so this may result in higher consumer prices. Joyce suggests that tariffs could disrupt supply chains but not lead to significant changes in US production in the short term. Additionally, the low-profit nature of the business could encourage foreign manufacturers to cut corners, potentially reducing drug quality. California's failed attempt to create its own generic drug industry illustrates the challenges in stimulating domestic production for these low-margin drugs.

While tariffs might encourage some domestic production, it could come at the cost of higher prices and possibly lower drug quality. The overall impact on the drug supply chain remains uncertain, with concerns about reliability and safety, especially if foreign manufacturers face increased production costs.

Joyce also describes what makes the generic drug market susceptible to supply chain disruptions; how the tariffs can affect price or competition within the branded drug space; health policy developments that coming down the pike that the pharma supply chain should prepare for; and much more.

What are the benefits of a completely open generic market powered by cash?

When we look at the generic drug market, we've done studies comparing what insured populations pay for generic drugs, and although the prices, the markups in dollar terms tend to be small (in percentage terms), the middlemen—the pharmacy benefit managers, etc.—make a lot of money off generics to a point where I'm not even sure they should be insured.

I think you could take them out of the insurance market. We did a study where generally, Costco beat Medicare Part D. Why? Because Costco, basically gets drugs from a wholesaler and tries to have a minimal markup, and try, in essence, to deliver value to their consumers. Once you go through these webs of insurance chains, insurance companies, PBMs, and these black, opaque boxes of everyone skimming at the top, generics are more expensive than they should be. I think if you had a completely open generic market, and people had to pay cash for it, I think actually that would improve the market.

In the final part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Geoffrey Joyce, PhD, director of health policy at the Leonard D. Schaeffer Center for Health Policy & Economics at USC, describes how PBMs financially benefit from generics, and why a completely open generic market powered by cash would be beneficial. 

The Rundown on Rebates

, Ed Schoonveld, value & access advisor for Schoonveld Advisory and author of 

, points out that the latest 15 drugs chosen for price negotiations under Medicare Part Dare not "negotiations" but rather government-mandated price reductions, based on a percentage discount determined by how far a drug is beyond its patent expiration. While the government has shown restraint in previous rounds, it’s expected that as more drugs are added to the list, Medicare pricing will experience a significant impact.

In this round, weight loss drugs like Ozempic, which have proven effective in managing diabetes, controlling HbA1c, and providing cardiovascular benefits, are included. However, these drugs are not yet approved for weight loss in Medicare patients, so their future role remains uncertain. While this could significantly affect Medicare pricing, Schoonveld notes that the private market is unlikely to be directly impacted by these changes in the short term. The government, however, influences physician fees for Medicare patients, which tend to be lower than those charged for privately-insured patients. This dynamic has led to the private sector subsidizing Medicare patients through premiums.

This trend may extend to drug pricing, where companies might raise prices in the private market to compensate for the government-mandated discounts in Medicare. Such changes could further strain the private sector, especially as employers and insurers are already expressing concerns about rising premiums and drug costs. Additionally, there is ongoing debate around potential restrictions on drug rebates, further complicating the financial landscape for both private insurers and consumers.

Schoonveld also offers a teaser on what to expect in his upcoming February “Value and Access” column.

What can readers expect from you February column?

 So my next column is going to talk about rebates. It's going to talk a little bit about, why are rebates bad? Why else would drug price controlling by the government be better? What are some of the drawbacks? What have we learned from some of the systems around the world? What are some of the drawbacks of that, and what are the points that we need to keep an eye on? What should be the focus of those programs, to make sure that we are keeping the patient in mind?

In the final part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Ed Schoonveld value & access advisor for Schoonveld Advisory and author of The Price of Global Health, previews his upcoming February column.

What Round II of Medicare Part D Drug Prices Signify for the Pharma Industry

With the Centers for Medicare & Medicaid Services (CMS) recently revealing its choices for the 15 latest drugs to be covered under Medicare Part D for the second cycle of price negotiations, what does this mean for future drug prices? What implications does this have for the private market?

 Well, they're not negotiations. That's the first part. Let's be very clear. This is a law that allows the government to basically dictate a percentage discount off the drug price, depending on how far this beyond patent expiration. Now the government has shown some restraint in the last round. I think we wanted to be careful not to maybe rock the boat too much. I expect over time—as more drugs are entering—this can have a substantial impact on the Medicare pricing. That's the goal, of course, as well. 

Now, in the current round, we're going to add 15 drugs. The next couple of rounds are going to be 15 drugs added. Of course, what you see here is that the weight loss drugs are added to the game. Ozempic is one of them. These drugs have clearly shown to be very good in helping diabetes patients with insulin, HbA1c control, and cardiovascular benefits as well, along with weight loss. Now, it's not approved for weight loss for Medicare patients, so that's something that we need to keep an eye on. We don't know where that's going to go. This is obviously a very big drug for Medicare, but also beyond Medicare.

In the first part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Ed Schoonveld, value & access advisor for Schoonveld Advisory and author of The Price of Global Health, comments on the future implications of the latest CMS drug price negotiations.

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