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 interview, Renier Brentjens, MD, PhD, deputy director and chair of medicine at the Roswell Park Comprehensive Cancer Center, discusses:

How he has seen the field evolve since its inception, and what excites him most about its future

How the Roswell Park expansion helps improve patient access to CAR T-cell therapy

The key safety concerns associated with CAR T-cell therapy, along with how Roswell Park aims to mitigate potential risks

How Roswell Park is working to make CAR T-cell therapy more widely available

The steps needed to be taken at the regulatory and healthcare policy levels in order to support the broader adoption of CAR T-cell therapy

Renier Brentjens, MD, PhD outlines the evolution of the space, while offering ways to boost patient access to these treatments. 

Embarking on the CAR-T Journey

 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

The telehealth site will welcome its own small-dose, compounded version of semaglutide, which mimics the function of a GLP-1.

Noom to Sell Microdoses of Wegovy

An NEJM study explores how this loss—following Medicaid disenrollment—affects beneficiaries.

How the Loss of Subsidized Drug Coverage Could Impact Mortality 

A qualitative study aimed to strengthen systematic repurposing efforts within rare disease nonprofit organizations, while also providing a framework for data-driven drug repurposing.

Themes Among Rare Disease Repurposing Efforts

Ways to reimagine pharma’s operating model and KPIs for commercial success in an AI-driven future.

Measuring What Matters

The move bolsters the CDMO’s commitment to cell and gene therapy by incorporating advanced manufacturing and fill-finish capabilities.

SK Pharmteco Debuts New cGMP Plasmid Suite 

HHS Policy Shift Could Boost Role of Patient Advocates in Clinical Trials

PC: How do you see the potential impact of HHS's proposed policy change on patient advocacy efforts, particularly for rare and serious diseases?

If I step back and think about how critical it is to receive input, feedback, and partnership from patient advocates—their voice is truly essential—it’s hard to overstate. At Neurvati and GRIN, we’ve embraced that view since our inception in September 2021. Some of our earliest hires were individuals who’ve dedicated their careers to advocating for patients and making their voices heard in the drug development process.

Maintaining mechanisms that allow patient advocates to express their views and collaborate with all stakeholders in drug development is incredibly important. It’s not just about understanding the patient journey—it directly informs how we design clinical trials. Patient and caregiver insights shape everything from trial design and site selection to endpoint development and regulatory strategy. Their lived experiences help us create more thoughtful, patient-centric research from the ground up.

The proposed policy change by the Department of Health and Human Services (HHS) that could reduce formal mechanisms for patient advocate input in regulatory discussions poses significant risks to drug development, especially for rare and serious diseases. Patient advocates are crucial in helping developers understand the lived experiences of patients and caregivers, especially in conditions with limited natural history data. Their insights inform decisions around clinical trial design, site and endpoint selection, and regulatory strategies. Organizations such as GRIN Therapeutics have prioritized patient advocacy from the outset, integrating advocates into their teams to ensure ongoing dialogue and collaboration throughout development.

Historically, public participation has been instrumental in shaping healthcare policy. For newly recognized or genetically defined diseases, patient advocates often provide the only frame of reference for symptom progression and caregiver burden. This input is invaluable not only to developers and regulators but also to payers making reimbursement decisions. High-cost, innovative therapies must demonstrate broad impact across disease symptoms to justify value, and advocates help articulate which symptoms matter most to patients. Their contributions help define clinical endpoints that better capture treatment effectiveness, supporting both regulatory approval and reimbursement.

If formal patient input mechanisms at the federal level were removed, drug developers would lose a vital perspective at a critical decision-making stage. While engagement can continue informally—through interviews, surveys, and other methods—losing the regulatory touchpoint would weaken the system. Nonetheless, developers can and should continue gathering robust patient and caregiver insights and proactively share them with regulators. In doing so, they help bridge any gaps left by policy changes and sustain meaningful engagement that ultimately benefits all stakeholders—patients, developers, payers, and regulators alike. This collaborative approach remains essential to ensuring the development of effective, impactful therapies for rare and serious conditions.

Bruce Leuchter, CEO, Neurvati, discusses the indispensable role of patient advocates—particularly in rare and serious disease drug development—in shaping trial design, site selection, and regulatory strategy.

FDA Uncertainty Sparks Shift Toward Outsourced Pharma Support

, Will Pih, co-founder, Two Labs, shared insights from his recent panel discussion on “Economics and Specialty Pharmacy for Rare Diseases: Challenges and Opportunities.” The conversation explored the growing complexities of delivering care in the rare disease space, particularly as specialty pharmacies and pharmaceutical manufacturers navigate high drug costs, small patient populations, and an evolving regulatory landscape. Pih discussed the need for innovation, patient-centric service models, and policy reform to ensure sustainability and access without compromising the quality of care.

PC: From your perspective, how is the current regulatory landscape either supporting or complicating rare disease access through specialty pharmacy?

That’s a tough question. There’s a lot of turmoil right now, and I think the main challenge is the uncertainty. Take the FDA, for example—there are many moving parts, and that uncertainty creates a kind of paralysis. People feel insecure and unsure of what to do next. They typically have a playbook they want to follow, but now that playbook is being paused or even rewritten. As a result, we’re seeing slower uptake in clinical trials and delays in hiring, as companies question what’s needed. Interestingly, this has actually benefited specialty pharma and pharma services overall—when companies delay hiring but still need to make progress, they often turn to outsourced services to keep things moving.

 The panel on "Economics and Specialty Pharmacy for Rare Diseases: Challenges and Opportunities" focused on the pressing financial and operational challenges within the rare disease specialty pharmacy landscape, particularly from both the pharmaceutical and patient/provider perspectives. With small patient populations and extremely high drug costs, rare diseases present unique difficulties for maintaining sustainable yet affordable care models.

Key innovations discussed included the evolution of patient services through advanced hub models. Pharmaceutical manufacturers are increasingly leveraging internal or third-party hubs that incorporate sophisticated technology and personalized support to enhance patient engagement. Specialty pharmacies, on their end, are refining rare disease training and clinical services, with a growing emphasis on patient-centricity, quality improvement, and tailored communication strategies.

Regulatory uncertainty was highlighted as a significant concern in 2025, with fluctuating guidance from agencies like the FDA creating hesitation in hiring and investment. This paralysis has led some organizations to turn to outsourced service providers, which may benefit specialty pharmacies and support vendors in the short term.

A central recommendation from the panel was to recognize specialty pharmacies serving rare disease populations as a distinct class of trade. The panelists argued that the level of service required for rare disease patients—often involving higher-touch care and more complex coordination—justifies differentiated reimbursement and policy consideration.

Looking forward, panelists expressed optimism about the pipeline for rare disease therapies, particularly with the growth of cell and gene therapies. As these treatments evolve from individualized products to off-the-shelf options, specialty pharmacies must prepare to support more complex therapies and new conditions they’ve never encountered before—marking a transformative phase in patient access and outcomes.

Will Pih, co-founder, Two Labs, explains how ongoing regulatory uncertainty is slowing clinical trial activity and hiring across the industry, prompting greater reliance on specialty pharmacy services and outsourced support.

Latest Conference Coverage

Asembia 2025: FDA Uncertainty Sparks Shift Toward Outsourced Pharma Support

Designing smarter interventions with community insights

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: What are some of the most impactful preventive strategies you've seen that truly bridge the gap in healthcare access?

Early in my career, I worked on projects that involved community health workers. People often ask, "Why community health workers?" The answer is simple—they live in the communities we aim to serve. They reflect the population, understand their challenges, and most importantly, they’re trusted. That trust allows them to bridge the gap in access to care. They help ensure patients get the necessary screenings, and they often connect people to critical resources like job support or food assistance. Their role is essential in reducing disparities and improving outcomes.

PC: How can providers and health systems better incorporate community input when designing preventive or educational interventions?

The key is to involve the community from the very beginning—during the planning phase, not just at the implementation stage. Too often, programs are created without community input and then presented as a finished product. That approach risks missing the mark. By giving the community a voice early on, we can better understand their real needs and tailor interventions that truly resonate and succeed.

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, explains how empowering trusted local leaders and involving communities early are key to closing persistent gaps in preventive care and healthcare access.

Asembia 2025: Designing Smarter Interventions with Community Insights

How Specialty Pharmacies Are Evolving to Support Rare Conditions

PC: You were a part of the ‘Economics of Specialty Pharmacy for Rare Diseases: Challenges & Opportunities’ panel. Can you provide a brief synopsis of what the session entailed?

The session centered around the current economic challenges in specialty pharmacy, especially in the context of rare diseases. Both manufacturers and specialty pharmacies are facing increasing pressure. With small patient populations and high-cost therapies, the financial dynamics become even more complex. The goal was to highlight these difficulties from both the pharmaceutical and provider perspectives.

PC: High costs are often unavoidable in rare disease therapies—what innovative strategies are you seeing to balance affordability and sustainability without compromising patient care?

There are several promising approaches. From the pharma side, particularly in rare diseases, there's a growing emphasis on enhanced pharmacy and patient services. Hubs are playing a more critical role—they're either developed internally, with proprietary technology and staff, or outsourced to external partners offering advanced platforms. Some companies are adopting hybrid models that combine both.

On the specialty pharmacy side, there’s impressive innovation around patient support. I’ve visited a few specialty pharmacies and seen firsthand the rare disease-specific training they provide. They’re continuously working on quality improvements in clinical care and call center interactions, becoming increasingly patient-centric to meet the complex needs of this population.

The panel on "Economics and Specialty Pharmacy for Rare Diseases: Challenges and Opportunities" focused on the pressing financial and operational challenges within the rare disease specialty pharmacy landscape, particularly from both the pharmaceutical and patient/provider perspectives. With small patient populations and extremely high drug costs, rare diseases present unique difficulties for maintaining sustainable yet affordable care models.

Will Pih, co-founder, Two Labs, explains how specialty pharmacies and manufacturers are adapting to financial pressures in rare disease care through patient-centric services, hub innovation, and hybrid technology models.

Asembia 2025: How Specialty Pharmacies Are Evolving to Support Rare Conditions

How AI and Payer Collaboration are Shaping Pharmacy's Future

, Chip Parkinson, the new CEO of Gift Health, shared his perspective on stepping into the role and the evolving challenges and opportunities across the healthcare landscape. Drawing on a diverse background that spans manufacturers, payers, and employer consulting, Parkinson discussed how his new position places him in closer contact with patients and prescribers than ever before. He also reflected on the state of specialty pharmacy, the potential of AI to improve access and affordability, and the importance of seeking diverse viewpoints in a rapidly shifting industry.

PC: As of today, you are the new CEO of GiftHealth. How has stepping into this role shaped your perspective going into events such as Asembia?

It’s been a significant shift for me. I’m now much closer to the patient than ever before. I’ve previously worked with manufacturers, payers, and served as a consultant to self-funded employers and health plans—all of which, in their own ways, serve patients. But at GiftHealth, we engage directly with patients and prescribers through about 4,000 calls a day. That level of interaction quickly reveals the real friction points they experience.

PC: How do you see the role of specialty pharmacy evolving over the next year based on the discussions and insights from Asembia 2025?

There’s a lot happening in specialty pharmacy right now. One major opportunity is to serve as the real-time connector between the patient, prescriber, and pharmacy. We've made progress over the past 15 years with near-real-time coordination, but now the focus is on enabling true real-time visibility. Giving patients and prescribers a clear view of how a prescription flows through the system is a big opportunity this year.

I also see significant potential in strengthening payer–pharmacy relationships. There’s been ongoing discussion about closer alignment between payers and specialty pharmacies to manage patient care in real time. Pharmacies that invest in the technology to become an extension of the payer’s care team will have a real advantage.

And of course, everyone is talking about AI. Specialty pharmacies are uniquely positioned to leverage AI to interrogate their data, uncover insights into the patient journey, and improve service delivery. Those that do it well will stand out in the market.

As of today, Chip Parkinson has stepped into role of CEO at Gift Health. Reflecting on the transition, Parkinson notes that this position brings him closer to patients than at any previous point in his career. With a background spanning manufacturers, payers, and employer consulting, he now sees firsthand the daily barriers patients and prescribers face—citing the company’s volume of 4,000 daily calls and 400 chats as a window into the patient experience.

Looking ahead, Parkinson sees several evolving roles for specialty pharmacies. He highlights the opportunity to better connect prescribers, pharmacies, and patients in real time—not just through improved logistics but with greater transparency into the patient’s journey. He also points to closer collaboration between payers and pharmacies as a potential area of growth, particularly where technology allows specialty pharmacies to integrate more directly into the care team. Parkinson emphasizes that artificial intelligence could be key in analyzing complex patient data sets—such as pharmacy claims and utilization management policies—to uncover patterns and inefficiencies that currently limit access.

When asked about prescription access and affordability, Parkinson suggests that AI may help better identify systemic barriers, using migraine treatment as an example where data gaps contribute to delays in care. He also discusses the growing demand for weight-loss medications, projecting major increases in utilization. Gift Health, he says, is looking into targeted interventions in underserved regions and through employer partnerships to address access challenges more effectively.

For other healthcare leaders attending industry events, Parkinson encourages building relationships outside familiar networks. He stresses the value of engaging with those who may hold different perspectives, particularly in a rapidly changing environment where policy, drug availability, and access continue to shift.

Chip Parkinson, CEO, GiftHealth, explains how AI, real-time data, and closer payer collaboration are driving the next phase of growth and efficiency in specialty pharmacy.

Asembia 2025: How AI and Payer Collaboration Are Shaping Pharmacy's Future

Why Distractions Are Detrimental to Business

 CEO of Theratechnologies, explains how Theratechnologies' operations have been impacted by recent US tariffs on Canadian goods, especially concerning the manufacturing and supply chain for its HIV therapy, EGRIFTA SV. The active ingredients used in EGRIFTA SV come from the US, travel to Canada for additional processing, and then return to the US for final assembly. As a result, the company faces tariffs on both the raw materials and parts of the manufacturing process that cross the US-Canada border. While the tariffs will increase costs, the company benefits slightly since the tariffs are applied to raw materials and intermediate steps, rather than the fully finished product, which would have resulted in a higher cost increase.

Theratechnologies is currently assessing the full impact of these tariffs on its supply chain, including effects on insurers, governments, and patients. Despite these challenges, the company remains committed to ensuring timely delivery of its therapies to patients, managing the increased costs as best as possible.

Levesgque also comments on the forecasted obstacles regarding the availability of specialty medicines for US patients; making the decision to reshore manufacturing processes; and much more.

Note: The FDA approved the company’s supplemental Biologics License Application (sBLA) for the F8 formulation of tesamorelin for injection on March 25. The new formulation will be commercialized under the tradename EGRIFTA WR and is expected to EGRIFTA SV.

Why are distractions detrimental to business?

This creates distraction. Distraction is never good in business, especially if you drive innovation and you're focusing on bringing solutions to patients. I think the situation is uneasy, because, first of all, we're not totally sure that we have the facts to actually juggle with this issue the best possible way and find a solution.

My last thought is, there's always a payer for medicine. Sometimes it's the patient, sometimes it's the government. If governments are basically taxing medicines, that means that governments that are reimbursing medicines will pay a higher price. That is bound to be an issue. The US government has an Inflation Reduction Act in place so that we cannot increase the prices of medicines for the medicines they are imbursed. They want to control cost.

Well, governments in Canada and elsewhere have the same type of approach, so that is really opening up a potential can of worms that could create a lot of grief. How it will settle, I don't know, but I think that the people that are putting in place these changes now have not assessed that properly, and it will have repercussions. As I said before, I think the pharma industry will be nimble again, will stay focused, and will try to identify solutions. There are potential solutions, but as I said, most of them cannot be implemented on a dime. It's a significant disruption in the way we operate, especially for two countries that are so intertwined in all they do, as Canada and the US are.

In the final part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Paul Levesque, CEO of Theratechnologies, describes the uneasiness behind regulatory complications. 

Will Moving Drug Production to the United States Help or Hurt Patients?

What obstacles do you foresee regarding the availability of specialty medicines for US patients—as a result of supply chain challenges—and how can biopharma companies address these issues?

If you're manufacturing, you're really upstream, and you are looking for your first, contract development and manufacturing organization (CDMO). In light of this situation, now, you're going to try to get a CDMO that operates in the US, but if you're currently manufacturing elsewhere, this transition cannot happen on a dime. We're talking about years, we're not talking about months. There won't be any short-term solutions, and unfortunately, tariffs will apply and will will probably have an impact on the value of medicines. There's no other way.

Is the solution 100% to actually use a CDMO in the US? It could be, but again, I'm intrigued by the effect that it's going to have on pricing, and I think it will be a negative for us patients.

In the third part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Paul Levesque, CEO of Theratechnologies, explains what the mindset be for companies who are just starting the reshoring process.

Why Patient Empowerment is Key  

 executive director at the Otsuka Patient Assistance Foundation, discusses two key sessions: "Establishing and Transitioning to a Foundation" and "Empowering Patients to Take Control of Their Healthcare." The first session focuses on the important aspects of transitioning to a foundation, emphasizing the risks associated with regulations and the need for robust patient support programs. The second session highlights the importance of guiding patients through their healthcare journey by removing barriers and enhancing their health literacy, helping them make informed health choices.

Thorpe outlines three critical factors when creating an independent patient assistance program (PAP) foundation: risk tolerance, conflict of interest, and funding stability. These factors are essential to ensure the successful operation and long-term sustainability of the foundation. She also stresses the importance of maintaining clear separation between the foundation and its core business operations, focusing on good stewardship and well-defined guidelines.

Thorpe emphasizes the significance of patient empowerment, noting that most patients struggle with understanding healthcare terms and concepts, with many having low health literacy. Empowering patients by improving their understanding of healthcare options is vital to help them make better health decisions.

Regarding digital innovation, Thorpe explains that while digital tools are crucial for patient engagement and literacy, they must be simple and engaging. Given the overwhelming digital landscape patients face, it’s important to create experiences that are easy to navigate and actively keep patients engaged, as prolonged use can be challenging. Simplifying digital interactions helps avoid patient fatigue and ensures long-term engagement.

How can foundations ensure that they maintain strong patient support while operating separately from their core businesses?

 In general, foundations should really have separation, and that separation is really focused in on two factors. Number one, good stewardship, and building cohesive guardrails and guidelines that offset those parameters for both the manufacturer as well as the foundation.

 Empowering patients is really important because patients do not understand healthcare in general. Nine out of 10 patients do not understand simple healthcare terms. Thirty-three percent of our population reads at a third-grade level, so health literacy is very important when building patient assistance programs, because we really want the patient to embrace their health journey and make good health choices. Without that education and that knowledge, they are at a disadvantage, and we want to broaden their awareness and their understanding so that they can engage in their health journey.

What role does digital innovation play in enhancing patient engagement and healthcare literacy?

 Digital technology is, of course, extremely important across all entities. We're really engaged with the digital innovation. With regard to foundations in patient support, understanding the patient journey is key. Digital innovation may or may not work for the patients that we serve. When you do have digital innovation, keep it engaging with what the patient is doing, what the patient is experiencing in their health journey, and then keep it simple. We want simplicity when we're talking to our patients. They are so engaged with all these digital components, that it's almost overwhelming, and so we want it engaging and simple. Keep it active. One of the biggest things is the boredom that happens—patients engage for a little bit, but not for a long term. And so, how do you keep it engaging, and how do you keep patients active in utilizing the digital tools?

In the final part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Rachel Thorpe, executive director at the Otsuka Patient Assistance Foundation, emphasizes the importance of the separation of core business and foundation, the value of patient empowerment, and the impact of digital innovation. 

PAP 2025: Why Patient Empowerment is Key  

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.

Building a Thriving Culture

, Kimberly Westrich, MD, chief strategy offer at the National Pharmaceutical Council, describes how in response to rising healthcare costs, employers have turned to high-deductible health plans and higher out-of-pocket (OOP) expenses, causing patients to pay more for healthcare. To help alleviate this financial burden, manufacturers offer copay assistance programs, which are aimed at improving medication adherence and preventing disease progression. However, insurers have introduced cost-shifting programs such as copay accumulators, maximizers, and alternative funding programs (AFPs) to manage these costs.

Copay accumulators redirect the value of copay assistance to the insurance plan instead of counting it toward the patient's OOP max or deductible. This means that patients face surprise copay costs once the copay assistance runs out, essentially "double dipping" as the plan captures the benefit without applying it to the patient's financial responsibility.

Copay maximizers also shift assistance from the patient to the plan but manipulate the patient's copay to extract the maximum benefit from the copay assistance. While the copay assistance helps with a specific medication, it doesn't count toward the patient's deductible or OOP max for other expenses, leaving the patient responsible for other costs.

Alternative funding programs (AFPs) are more complex. In these programs, certain specialty medications are removed from insurance coverage, and patients must enroll in an AFP. They work with a third-party vendor to obtain the medication, often through manufacturer assistance, charity programs, or international pharmacies. While the AFP may provide the medication, it can be a slow and confusing process, and patients may not qualify, leaving them to pay out of pocket or forgo the medication. These cost-shifting strategies aim to manage healthcare expenses but can create additional financial and logistical challenges for patients.

Westrich also comments on how these accumulators, maximizers, and alternative AFPs are impacting patients, manufacturers, and healthcare ecosystems; sessions that have caught her eye; and much more.

What other sessions have caught your eye at Hub and Specialty Pharmacy Models East?

Unfortunately, I wasn't able to be here for the entire conference. I really wish that I could have been, but I did have the fortune to attend the session—which was immediately before my session—and Dolores and Amanda from EMD Serono talked about their thriving culture.

This is the kind of session that you might not expect to sit in at a conference like this. I personally really enjoyed it. I have multiple hats at the National Pharmaceutical Council (NPC), and while one of my hats is looking at the employer-sponsored insurance world and doing policy relevant research, one of my other hats is related to culture, and I oversee our culture initiative at NPC.

Last year, we were chosen as a great place to work, and that's been really important and exciting to me, so in this particular session with Dolores and Amanda, I was really interested in hearing about the things that they've been doing to deliberately have an open culture, a culture that has shared values and cultural curiosity. It was really interesting for me to hear how another organization approaches it, to have that overlaid with this particular conference, because they also wove in some information about their PAP program and how all of this fits together, so I really enjoyed hearing that.

 anniversary last year, and I believe that one of the reasons that we are so successful—we have such longevity as an organization—is the focus that we put on our culture. I'm excited to take some of what I heard from Amanda and Dolores back to the office with me, and share some of their ideas with my colleagues and see how we continue to raise the bar—as Amanda and Dolores said today—on excellence.

In the final part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Kimberly Westrich, chief strategy officer at the National Pharmaceutical Council, comments on another presentation that has caught her eye at the conference. 

Patient Support

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