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 podcast where we bring you the latest insights shaping patient access, supply chain/logistics, data & tech, and healthcare innovation. I’m your host, and today we’re covering updates in maternal health guidance, real-world diabetes data, and a new partnership aimed at lowering drug costs and improving access.

The American College of Obstetricians and Gynecologists (ACOG) has 

 its support for COVID-19 vaccination during pregnancy, even as it distances itself from recent CDC guidance. ACOG emphasized that vaccination remains safe and effective for protecting both pregnant individuals and their newborns from severe illness. The statement underscores ongoing efforts to ensure maternal populations remain a focus in vaccine policy, especially as hesitancy persists in some communities.

 shows that the SGLT2 inhibitors dapagliflozin and empagliflozin are safe and effective for patients with type 2 diabetes. The study found no new safety concerns, reinforcing their role in improving both glycemic control and cardiovascular outcomes. With diabetes prevalence continuing to rise globally, the findings strengthen confidence in SGLT2 therapies as a key option in managing long-term complications.

Lastly, in market access news, EVERSANA and Waltz Health are joining forces to 

 designed to tackle drug costs and improve patient access. The system leverages data, analytics, and real-time pricing to help patients and providers identify the most affordable options at the point of care. By combining EVERSANA’s commercialization expertise with Waltz’s technology, the collaboration aims to improve transparency and reduce out-of-pocket burdens for patients navigating an increasingly complex drug pricing landscape.

From maternal health guidance to real-world diabetes safety data and innovative pricing platforms, these stories highlight how science, practice, and technology are working together to improve patient care.

. For more insights on trends transforming pharmaceutical access and care delivery, visit 

Thanks for listening—until next time, stay well and stay informed.

This episode of Pharma Pulse covers ACOG’s renewed support for COVID-19 vaccination during pregnancy, new real-world evidence confirming the safety of dapagliflozin and empagliflozin for type 2 diabetes, and a partnership between EVERSANA and Waltz Health to improve affordability and patient access.

Pharma Pulse: ACOG Reaffirms COVID-19 Vaccine in Pregnancy, SGLT2 Real-World Safety Data, and EVERSANA–Waltz Tackle Drug Costs

 podcast where we bring you the latest insights shaping patient access, supply chain/logistics, data & tech, and healthcare innovation. I’m your host, and today we’re covering new digital access to GLP-1 therapies, a clinical trial setback for Pfizer, and the pros and cons of patient portals in connecting with physicians.

 with GiftHealth to expand access to GLP-1 weight loss and diabetes medications through LillyDirect, Eli Lilly’s direct-to-patient platform. The partnership combines Goodpath’s personalized care programs with Gifthealth’s pharmacy distribution capabilities, aiming to make it easier for patients to initiate and maintain therapy. With GLP-1 demand soaring, this collaboration could streamline prescribing and improve adherence, while bypassing some traditional access barriers.

 from a Phase III trial of its sickle cell disease treatment. The therapy failed to meet its primary endpoints, dealing a setback to Pfizer’s rare disease pipeline. The company says it will analyze the data further to understand the outcome and determine next steps. The news underscores the high clinical and commercial stakes in sickle cell research, where effective new therapies are urgently needed but remain difficult to achieve.

 highlights the growing role of patient portals in improving access to physicians, enabling patients to message providers, request appointments, and view medical records online. However, increased accessibility can also lead to a surge in message volume, contributing to clinician burnout and longer response times. Health systems are exploring ways to balance convenience for patients with sustainable workloads for providers, including message triaging and integrating AI tools to handle routine inquiries.

From digital partnerships expanding medication access, to clinical trial challenges, to managing the realities of online patient engagement, these stories reflect the fast-evolving intersection of pharma, technology, and healthcare delivery.

You can catch Pharma Pulse directly on 

This episode of Pharma Pulse covers a new collaboration to expand access to GLP-1 therapies via LillyDirect, Pfizer’s Phase III miss in sickle cell disease, and how patient portals are improving access to care while creating new workload challenges for providers.

Pharma Pulse: GLP-1 Access Partnership, Pfizer’s Sickle Cell Setback, and Patient Portal Trade-Offs

 podcast where we bring you the latest insights shaping patient access, supply chain/logistics, data & tech, and healthcare innovation. I’m your host, and today we’re covering three major developments—from new US policy on drug manufacturing to a high-profile pricing change for a leading obesity drug, and new research on vaccine safety.

 directing the creation of a domestic stockpile of active pharmaceutical ingredients, or APIs. The goal is to reduce reliance on foreign sources, strengthen the pharmaceutical supply chain, and ensure readiness for public health emergencies. This policy could have significant implications for manufacturers, potentially accelerating domestic production investments while reshaping global sourcing strategies.

 the UK list price of its GLP-1 drug Mounjaro by 170%. The company attributes the move to aligning prices with the therapy’s value and global market conditions, but the hike has sparked debate over affordability and access—especially as GLP-1 demand surges worldwide. Critics warn that higher prices could limit uptake within the UK’s National Health Service, while proponents say it may reflect the drug’s potential in addressing obesity and diabetes at scale.

 has found no link between aluminum-containing childhood vaccines and adverse health outcomes. Researchers reviewed decades of data and concluded that aluminum adjuvants, used to boost immune response, are safe and do not contribute to chronic illness. The findings are expected to reinforce public health messaging and counter misinformation, particularly as vaccine hesitancy remains a challenge in some communities.

From US manufacturing policy to international drug pricing and reaffirmed vaccine safety, these stories show how regulation, market dynamics, and public health science are intersecting to shape the pharma landscape.

This episode of Pharma Pulse discusses a new executive order to build a domestic API stockpile, Eli Lilly’s 170% price increase for Mounjaro in the UK, and long-term research confirming the safety of aluminum in childhood vaccines.

Pharma Pulse: US API Stockpile Plan, Mounjaro Price Hike in UK, and New Data on Vaccine Safety

 podcast where we bring you the latest insights shaping patient access, supply chain/logistics, data & tech, and healthcare innovation.I’m your host, and today we’re covering three key developments—from major manufacturing investments to a shake-up in pharmacy customer satisfaction rankings, and shifting insurance coverage for GLP-1 drugs.

to expand active pharmaceutical ingredient manufacturing in the United States. The move aims to strengthen domestic supply chain resilience and reduce reliance on overseas sourcing—an increasingly critical priority for both industry and policymakers. This expansion is expected to boost AbbVie’s capacity to produce high-demand active pharmaceutical ingredients for its branded and pipeline products, while supporting US-based jobs in advanced pharmaceutical manufacturing.

 on pharmacy customer satisfaction reveals that mail-order services and supermarket pharmacies are now outpacing traditional chain pharmacies in patient experience. Consumers cite convenience, better pricing, and shorter wait times as top drivers of satisfaction. This trend could influence prescription fulfillment patterns, with more patients turning to alternative pharmacy channels—particularly as health systems and retailers explore new distribution models.

Lastly, as demand for GLP-1 drugs for diabetes and obesity continues to surge, insurance companies are 

. Some payers are introducing stricter criteria—or even dropping coverage—due to escalating costs and long-term budget concerns. This shift raises questions about patient access and affordability, especially as GLP-1s remain among the most expensive chronic-use therapies on the market. Experts warn that without broader cost-containment strategies, many patients may be forced to discontinue treatment, potentially undermining clinical outcomes.

From bolstering US manufacturing capacity to responding to changing consumer preferences and navigating the economics of GLP-1 coverage, these stories highlight the evolving forces shaping pharma and healthcare delivery.

This episode of Pharma Pulse explores AbbVie’s $195 million investment to expand US API production, new survey results showing mail-order and supermarket pharmacies outpacing traditional chains in customer satisfaction, and rising affordability pressures as insurers restrict GLP-1 coverage.

Pharma Pulse: AbbVie Boosts Domestic API Manufacturing, Supermarkets Lead in Pharmacy Satisfaction, and GLP-1 Coverage Tightens

How recent executive orders—both under the Biden and Trump administrations—have reshaped the drug pricing landscape, and the legal challenges or uncertainties they present for pharmaceutical companies

What life sciences companies should be doing now to proactively prepare for further executive action on drug pricing and market access

The key differences in how executive policies versus legislative actions affect the pharma industry’s pricing and commercialization strategies

The legal and strategic risks executive policy shifts pose to investors and biopharma leaders who may be planning product launches or portfolio expansion over the next few years

Alice Valder Curran outlines the steps manufacturers should take to better prepare for upcoming executive actions on drug pricing and market access.

How Recent Executive Orders Impact the Drug Pricing Landscape

The merger integrates EVERSANA’s commercialization services with Waltz Health’s AI-powered payer tools to address patient affordability, streamline drug access, and reduce costs for high-expense therapies such as GLP-1s.

EVERSANA, Waltz Health Form Combined Platform to Tackle Drug Costs and Access Challenges

As pharma drug pricing debates heat up, the 340B program faces mounting challenges from outdated regulations, duplicate discounts, and limited transparency. 

340B Litigation and the Path Toward Transparent Drug Discount Programs

From rethinking launch price logic to implementing rebate-aware modeling and patient-first access programs, this installment explores how disciplined governance and forward-thinking models can safeguard profitability in a volatile market.


Popping the Gross-to-Net Bubble, Part V: Innovative Pricing Models

The GSK Flovent example highlights the consequences for patients and pharma of the decision to eliminate the Medicaid rebate cap.

A Rebate Double-Whammy: Exploring the Unintended Consequences 

In the third part of his Pharma Commerce video interview, Marschall Runge, MD, PhD, dean of the University of Michigan Medical School and author of The Great Healthcare Disruption, proposes ways to ensure both fiscal responsibility and the sustainability of hospital funding.

Reducing Healthcare Prices

Gross-to-Net Bubble Reshapes Drug Pricing Strategy

This video was created based on Bill Roth's "Popping the Gross-to-Net Bubble" 

Welcome to the explainer. Today, we are talking about the wild and honestly, super complex world of drug pricing, and we're going to tackle what some experts call the gross-to-net bubble. It's a huge shift that's happening right now, and you need to know about it.

So let's just jump right in with a question that gets to the absolute heart of this whole thing. Why is the price you hear about for a drug—you know, it's list price—why is it basically just an illusion? What's the real story behind that number? Well, the answer really boils down to this one critical term, gross-to-net, or GTN for short. The easiest way to think about it is this. It's the massive and usually invisible gap between a drug's official sticker price and the actual cash a drugmaker gets to keep—all those rebates, discounts, and fees live inside that gap, and they bring the real price way, way down.

Okay, so to really get where things are headed, we first have to understand the old way of doing things, the old playbook for pricing drugs. And let me tell you, it's an approach that has a massive hidden trap built right into it. For years, the logic seemed to make perfect sense, right? A new drug gets approved, what's the first thing you do? You go cut deals with the huge commercial insurance managers, the PBMs. Why? Because they control access to millions of patients. You get in good with them. You get massive volume. Simple, but here's the deep flaw in that logic. When you chase volume with those big commercial players, first, you're ignoring a completely different and incredibly powerful set of rules, government pricing regulations, and trust me, those rules can come back to haunt you and cause your actual revenue to just collapse later on, and we're not talking about some small niche problem anymore.

The ground has completely shifted under everyone's feet. The whole landscape of who actually pays for drugs in the US has fundamentally changed the old rules, they just don't work anymore. This is the number that changes absolutely everything—over 55%. That's how many Americans now get their prescriptions covered by government programs like Medicare and Medicaid. That's not just a big number. That's a tipping point. This new reality is nothing short of a seismic shift. Government payers are no longer just a part of the market. They are the market. They're the majority now. So if you ignore their rules, you're literally ignoring the biggest, most powerful player at the table.

So here's the takeaway—you have to flip the entire model on its head, that old commercial first playbook. It's done. The new game is all about building your pricing strategy on a solid foundation from day one. The 

actually uses a perfect analogy for this. It's like building a house you would never, ever try to put up the walls and the roof before you've poured a solid concrete foundation, right? It would be a disaster in this world. The foundation is understanding all of those government or statutory pricing rules. Then you can think about the commercial deals, the walls and the roof and this new statutory first model.

It's a clear three-step process. First, you have to forecast your patient mix, who's going to be using your drug. Second, based on that, you model the absolute lowest price you can have because of government rules. And only then, as the third and final step, do you start layering those commercial deals on top of that solid base. Adopting this model forces you to ask much smarter, long term questions, you start thinking, hmm, if we raise the price, will that trigger inflation penalties, or wait, if we give this one HMO a super deep discount, could that accidentally set a new best price that we then have to give to the government for free? You see, you're no longer just reacting. You're playing chess, not checkers. And look, this is so much bigger than just a new process for the pricing department, this requires a whole new strategic discipline that has to run through the entire company. It's a move away from just reacting tactically to having a real long-term, enterprise-wide strategy.

So what does this actually look like in a company that gets it right? Well, they have what the experts call mature GTN governance. This means they have high-level steering committees looking at the whole portfolio. They use standardized decision models to avoid making costly one-off mistakes. They're constantly planning for downside risk and making sure that everyone from marketing to finance to legal knows who is accountable for what here's the bottom line, gross-to-net is not just some number that an analyst at a back office calculates anymore. It's a C-suite, top-level priority in today's market, having a smart GTN strategy is one of the most critical factors that determines whether a drug brand lives or dies.

Which brings us to this, final, really provocative question. The commercial PBMs, sure, they might have the loudest voices in the room, but the real rules of the game—those are being written by the government now, and the companies that understand this, the ones who play by those rules first, they're the ones who are going to win.

As over half of Americans now receive prescriptions through Medicare or Medicaid, pharma companies must shift from a commercial-first approach to a statutory-first model, making GTN governance a C-suite priority for long-term brand survival.

How Pharma Can Remain Competitive Amid Rising Healthcare Costs

, Philip Sclafani, PwC's pharmaceutical and life sciences lead, he describes how the One Big Beautiful Bill Act (OBBBA) is expected to significantly influence prescription drug spending by reshaping access and reimbursement within Medicaid, certain Medicare segments, and ACA exchange plans. The OBBBA introduces pressure on pharmaceutical revenues, particularly by limiting coverage for high-cost drugs in publicly funded markets. This could reduce patient access to specialty medications and diminish pharma sales in those sectors.

Simultaneously, broader market forces are also impacting prescription drug trends. On the private commercial insurance side, cost inflators like the rapid growth of GLP-1s and behavioral health treatments are emerging, while biosimilars act as deflators. The intersection of these trends—OBBBA and private market shifts—presents a complex environment for pharmaceutical companies.

To mitigate financial risks and preserve innovation, pharma firms are being pushed to accelerate R&D investment and pursue mergers and acquisitions (M&A) that bring in near-term revenue and long-term pipeline potential. There’s also growing interest in global licensing deals, including accessing drug pipelines from China for US or ex-China markets.

At the operational level, companies are responding to tighter margins by improving efficiency—through digitization, AI integration, and reevaluating commercial spend, such as Salesforce deployment and direct-to-consumer marketing.

Overall, Sclafani emphasizes that OBBBA is just one factor within a larger industry shift, and successful pharma companies will need to respond holistically—balancing cost containment, innovation, and strategic partnerships to adapt to this evolving landscape.

He also comments on balancing the demand for innovation with increasing payer pressure to control costs; the role biosimilars play in long-term cost containment strategies; operational and pricing strategies pharma executives should prioritize in order to stay competitive while ensuring patient access and affordability; and much more.

With healthcare costs projected to remain elevated at 8.5%, what operational and pricing strategies can pharma executives prioritize to stay competitive while ensuring patient access and affordability?

It's a challenging time with health costs not really sustained on this increased path, and sometimes, I think the medical cost trend can be misinterpreted. It never has decreased in the time we've been doing this. It's just lower rates of inflation or higher rates, and we're in this period of high inflation.

I'd say one thing—if you look back over the time period when we see this consistent higher healthcare increase trend, we have tended to see legislation or major policy shifts try to come in place as sort of macro deal with those. I think it remains to be seen if we'll see another bill coming this year, and that's certainly one thing pharma’s looking out for. We had the OBBBA now, and maybe there'll be more. But historically, you look back at the highest cost times, the Affordable Care Act came, or during COVID, there was the Cares Act. Obviously, that was a once-in-a-generation event, hopefully limited, once in a 100-year event, hopefully, but we saw some legislation there.

I think that's one of the big watch outs that will both impact pharma and pharma will respond to is because we're in this period of multiple years of higher almost getting up to 10% costs increases, might we see some more government intervention? Potentially, outside of that, there are levers we expect to see pharma companies pull. I think I mentioned a few before, but thinking about optimizing commercial operations to be as lean and tech-driven as possible, that's going to take some time in different areas, but optimizing the supply chain is probably a very timely question. Thinking about the tariffs that were just announced in the EU and so far, expect to impact pharmaceutical products, that's another major inflator. Pharma will have to look at strategies to onshore, in order to optimize the supply chain, things like that, to just even prevent terrorists from further raising prices in the market.

We think about really focusing on innovation. I think pharma companies already spend a lot of time on health economics and what it means. There's no question that the direct cost of a pharmaceutical, a prescription drug, increase cost as soon as it's dispensed and taken by the patient. The goal, though, is that will get those patients stable to whatever the clinical goal is, which will have an impact on health economics and costs going forward. Engagement with payers and PBMs is always critical as much as possible, trying to get to the collaborative solutions and less back and forth over prices and rebates.

It's always going to be there, but what's the right balancing act? What is the population that should be insured and covered for this treatment at that negotiated price that's going to get there? I think for pharma, if you look at it, there is no way to price increase your way out of these challenges; there are price protections and commercial agreements. There are CPI-U penalties, Medicaid, and now, Medicare inflationary penalties. There's very limited value in increasing prices. It's really focused on, how do I get to more efficient operations on the L side of the P&L, and how do I get to the right sort of coverage and value equation with different payers and PBMs here in the US, not too dissimilar from what happens in a lot of European countries. You have to do it a whole bunch of times here in the US, versus one national health technology assessment, all of that. We don't have that model here, but I think you're still assessing how many patients will be covered at what price, getting to what value.

In the final part of his Pharma Commerce video interview, Philip Sclafani, PwC's pharmaceutical and life sciences lead, discusses operational and pricing strategies pharma executives can adopt to navigate sustained cost inflation, including supply chain optimization, payer collaboration, and value-based approaches to ensure patient access and affordability.

Facing a Crossroads

He also comments on balancing the demand for innovation with increasing payer pressure to control costs; the role biosimilars play in long-term cost containment strategies; operational and pricing strategies pharma executives should prioritize in order to stay competitive while ensuring patient access and affordability;

How do you foresee the One Big Beautiful Bill Act (OBBBA) reshaping prescription drug spending, and what strategies should pharmaceutical companies adopt to mitigate its potential impact on innovation, R&D investment, and M&A activity?

Starting out with the One Big Beautiful Bill, I kind of look at a couple things that are happening at the same time. The OBBBA passed, and that's primarily impacting the government side of things, so Medicaid, a little bit of Medicare, and then the ACA exchange plans. At the same point, a happy coincidence—at the same time, we put out our “Behind the Numbers Medical Cost Trend Report,” and that's primarily looking at the private commercial insurance market.

There are significant trends and inflators going on over there, with the rise of GLP-1s and some behavioral health neurosciences, as well as some deflators, with the biosimilars coming in and having an impact. I focus on the totality of it. If you look at all the big trends, that's really what's driving a lot of pharmacy benefits and prescription drug strategies. If you look at pharma companies from multiple angles facing potential loss of sales, having less patients insured on the Medicaid side and ACA exchanges certainly will impact the availability of those patients to use, access, and pay for prescription drugs, particularly specialty medications. Regarding higher cost, there'll be a challenge there.

We think about those patients, unfortunately not being able to get all the prescriptions they would want, spending and pharma company revenues going down there. On the other side, we do see significant innovation coming in from newer therapies, obviously GLP-1s continuing to grow, and others. So I think it's important to look at the totality. It's a challenging environment.

From an overall gross-to-net perspective, pharma continues to pay more discounts and rebates and things like that to payers, PBMs, health plans, hospital systems, etc. And then on the other end, you've got One Big Beautiful Bill reducing access and coverage, which could be a challenge. I think the natural response you look at is there is a near-term revenue gap for some, so that's prioritizing and accelerating R&D investments, looking at M&A activity that adds revenue now, but also has some longer-term either indication expansion or pipeline potential.

We also see some innovative deals starting to access molecules or pipelines from China that potentially could be brought to the US or ex-China markets. And then the last piece, I think, whenever you have this kind of revenue and profitability push, there's a natural look to get more efficient in operations. Some of that is digitizing the operational core of the company. We see a lot of AI and other use cases in there. In other cases, it's reevaluating, just overall, you know, how much are we spending on Salesforce, DTC, other things like that. I think you see a little bit of push from both, and One Big Beautiful Bill is certainly one piece that fits into the overall picture driving that.

In the first part of his Pharma Commerce video interview, Philip Sclafani, PwC's pharmaceutical and life sciences lead, shares how he foresees the One Big Beautiful Bill Act reshaping prescription drug spending, and what strategies pharmaceutical companies adopt to mitigate its potential impact on innovation, R&D investment, and M&A activity.

The Ripple Effect of 200% Tariffs on US Drug Supply and Pricing

, Brad Stewart, BDO’s national life sciences co-leader, describes how a proposed 200% tariff on pharmaceutical imports could have significant short- and long-term impacts on US drug manufacturing and distribution, with immediate concerns focused on the stability of the generic drug market. According to Stewart, generic drugs make up the majority of medications used in the United States, but they are highly vulnerable to shortages because many become sole-source products after their initial launch. Within a few years of going generic, multiple manufacturers often consolidate into a single supplier due to limited demand and low margins. This leaves the supply chain fragile, as any disruption—such as shortages of active pharmaceutical ingredients (APIs), manufacturing conflicts, or facility issues—can quickly lead to supply gaps. The pandemic underscored these vulnerabilities.

In the short term, Stewart warns that a 200% tariff would exacerbate these challenges by increasing the costs of imported generics, which are critical for maintaining affordable drug access. This could limit availability and raise costs for patients, providers, and insurers, leading to potential shortages and higher out-of-pocket expenses.

Longer term, tariffs of this magnitude would likely drive a rise in overall drug prices in the United States. Companies would have little choice but to pass on increased costs to consumers, insurers, and healthcare systems. While patients might not feel the impact immediately due to insurers absorbing costs, premiums, and healthcare charges would eventually rise.

Stewart emphasizes that reshoring pharmaceutical manufacturing is not a quick fix. Building new manufacturing facilities or scaling domestic production requires a long lead time—typically three to five years—and involves complex regulatory and logistical challenges. As a result, while tariffs may encourage companies to explore onshoring, significant capacity expansion is unlikely to occur in the near term.

Stewart also comments on the internal constraints that nearly a quarter of life sciences CFOs are reporting as their biggest manufacturing obstacle; how artificial intelligence can help support pharma leaders in managing their supply chains; and much more.

What immediate and long-term impacts could a 200% tariff on pharmaceutical imports have on US drug manufacturing and distribution operations?

To get to a 200% tariff being implemented and what the impacts would be, I think both short and long term, they're pretty easy to see, and most of them probably don't result in a massive growth in US drug manufacturing in the next several years. That’s something that's very hard to do with drug manufacturing, and we'll talk about why in a minute, but probably in the short term, I think the biggest concern I would have is around generic drugs.

That's really one of the areas that I think people don't realize is probably one of the most unstable parts of drug infrastructure for the United States—generic drugs very commonly these days end up being sole-source medications. For the first six to 12 months that a drug becomes generic, there might be multiple manufacturers, but unless they're incredibly high volume, they tend to become sole source over the first couple of years, and we see what happens now with drug shortages. We saw this quite a bit during the pandemic.

It's not uncommon for a drug—maybe the active pharmaceutical ingredient, or API—to end up in shortage. There's conflict with what else they're trying to manufacture—they can't produce the volume or maybe there're facility issues. I think short term, that's really what I worry about, is just not having access to generic drugs, which are by far the vast majority of the drugs that people in United States take. Long term, longer term, or maybe midterm, it's definitely going to raise drug prices the United States. Companies will probably have no choice but to raise prices with a 200% tariff. That'll start to impact what people pay out of pocket, what they pay for health insurance, what hospitals are charging, those sorts of things.

Maybe you don't see it in your co-payment right away because your insurer is having to absorb that until they raise your premiums in the next benefit season, but I think in the longer term, that's where companies really are going to have to try and figure out if there are opportunities for them to onshore parts of their pharmaceutical production and those sorts of things. As I started to say before, those are very long term, very challenging decisions. These are typically three-plus years to three to five years, probably most honestly, to try and build and open up a manufacturing facility.

In the first part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Brad Stewart, BDO’s national life sciences co-leader, describes the immediate and long-term impacts of this potential levy on pharma imports.

How Competition, Access, and Reimbursement Will Shape the Next Wave of Innovation

, Murray Aitken, executive director of the IQVIA Institute for Human Data Science, explains the extensive process behind developing the “Global Use of Medicines Outlook Through 2029” report. The creation of this comprehensive resource spans several months and integrates proprietary IQVIA datasets, including the MIDAS (Market Intelligence Data Analytics Solution), market prognosis, and forecast link tools. The report combines robust data analytics with global expert insights to produce a holistic view of the pharmaceutical landscape.

Aitken emphasizes that a key part of the process involves gathering input from IQVIA’s network of experts across the world, each bringing localized perspectives on evolving trends in medicine use, access, and policy. These expert insights are then synthesized by an internal analytics team responsible for compiling the vast volume and value data.

In terms of metrics, the report estimates that 3.6 trillion defined daily doses of medicines were consumed globally in the past year. Additionally, the worldwide expenditure on medicines is projected to be approximately $1.8 trillion at list prices in 2024. Aitken notes that while there are some data gaps, IQVIA’s methodology includes filling in missing information using statistically sound models and expert validation.

The ultimate goal of the report is to provide all healthcare stakeholders—governments, policy makers, pharma executives, and researchers—with a clear, data-driven understanding of where medicines are being used, how frequently, and at what cost. Aitken concludes by expressing pride in his team’s efforts and the value the report brings in shaping discussions around global health policy, drug affordability, and resource allocation.

He also comments on how pharma companies should revise their market access and pricing models to align with the evolving landscape; strategies manufacturers should adopt to balance investment in innovation with lifecycle management in order to maintain sustainable growth; how the competitive landscape will evolve within these high-impact therapeutic areas, the role patient access and reimbursement play in shaping adoption; what he anticipates for the biosimilar adoption curve in key markets over the next five years; and much more.

The report identifies obesity, oncology, and immunology as key contributors to global spending growth through 2029. How do you see the competitive landscape evolving within these high-impact therapeutic areas, and what role will patient access and reimbursement play in shaping adoption?

So obesity is the one that obviously gets a lot of public attention. This area is going to be very competitive very quickly. We have two companies competing there now, but we see a very extensive pipeline of new mechanisms, new formulations, new indications being developed for not only GLP-1s, but again, many other mechanisms as well. We can see 173 molecules in active development in the pipeline. They're not all going to make it to market, but enough will to make this a highly competitive marketplace. We should also recognize that currently, most of these obesity drugs are not reaching the patients who will benefit the most from them, so we've still got this big opportunity to help patients with weight loss who will benefit from it, in terms of reduced incidence of diabetes, cardiovascular disease, and many other diseases as well.

Reimbursement is still a barrier in this case, I'm confident that we have enough clinical data coming through showing the efficacy, benefits, and value of these medicines that we will see reimbursement opening up over the next several years. I also see so much competition coming through the pipeline that we'll see prices being reduced from their current levels, and those two might happen simultaneously. This is going to be a very dynamic space. It's a big market, but more importantly, it's a transformational therapy area, and I think we're only seeing the very beginnings of what impact that will have.

In the case of oncology, this is already by far the largest therapy area, and we expect that growth will continue. We can see about 100 new oncology drugs will be launched over the next five years. It's become very competitive. It's also become very much a precision medicine area. That brings some complications—the need and reimbursement for diagnostics, in addition to the therapeutics, is something that in some parts of the world is still very much a problem. There's still significant unmet need. We're going to see continued demand for these new drugs.

The other dynamic, though, is that we are seeing the loss of exclusivity beginning within the next five years, particularly of pembrolizumab, which is the largest oncology drug. We expect that will lose exclusivity in the 2028, 2029, 2030 period, so we are forecasting actually a slowdown in the growth rate in spending on oncology medicines, partly driven by that loss of exclusivity. In fact, we're forecasting that on a global basis, growth will fall under 10% by 2028-2029, and even less in in the important US market. There are some dynamics playing out there.

In terms of immunology, we still have significant unmet need. It's a competitive market, but we are seeing the impact of the losses of exclusivity of some of the larger leading products, such as adalimumab, that's also bringing down the growth rate in spending on these medicines. It's also heightening the competitiveness in this space, the need for companies to bring forward evidence that differentiates their drugs, perhaps in narrower sub populations, rather just at the overall market level.

In the final part of his Pharma Commerce video interview, Murray Aitken, executive director, IQVIA Institute for Human Data Science, details how he sees the competitive landscape evolving

The Biosimilar Void

Despite the strong pipeline of innovation, biosimilars continue to deliver significant cost offsets, especially in mature markets. What do you anticipate for the biosimilar adoption curve in key markets moving forward?

Over the last five years in the US, we've had some issues in terms of the way in which the biosimilar market has evolved. In the case of the Part B drugs, hospital-infused drugs, and so on, we have the pricing mechanism that is really not designed for biosimilars, and which is driving costs and prices down in the marketplace to the point where they may be actually too low. For Part D drugs, we have formulary management that goes on by the PBMs, which in some cases, is restricting access to the lower-cost biosimilars. These are distortions in the market that we think are not ideal, and they should be addressed in order for biosimilars to play a key role.

In Europe, we have a version of the same sort of mechanisms where pricing has been driven to very low levels, to the extent that we now have what we are referring to as the biosimilar void. This is when we look in the pipeline of new biosimilars being invested in by similar manufacturers for the next wave of biologics that will lose exclusivity, we see a lot of gaps. We see a void. We're not seeing as much investment, both in the manufacturing capacity or in the R&D to bring new biosimilars into the market.

That lack of investment means there will be less competition from biosimilars, and ultimately, that isn't desirable for the health system, for patients, and I think it's something that does need to be addressed rather urgently, so that we can create an environment where biosimilars have an important, meaningful role to play in the context of the overall system.

In the fourth part of his Pharma Commerce video interview, Murray Aitken, executive director, IQVIA Institute for Human Data Science, outlines what he anticipates for the biosimilar adoption curve in key markets moving forward.

Balancing Innovation and Lifecycle Strategy in the Era of the IRA 

What strategies should manufacturers adopt to balance investment in innovation with lifecycle management, in order to maintain sustainable growth?

There's always this balance between how much are you investing in the novel, breakthrough therapies and how much are you investing in maintaining presence of some of the older drugs, particularly as they lose exclusivity. I sort of come back to the fact that manufacturers overall have really been doubling down on their strategic focus on innovation. If you look across the largest companies over the last five, 10 years, they've all narrowed their focus in on innovative medicines, and ultimately, that's where they believe their sustained success is going to come from.

That being said, when a drug loses exclusivity, of course, that’s where we see the introduction of generics or biosimilars. I think we do see different strategies by different companies. Some definitely try to cling on to the originator drug as long as they can, and through contracting and other mechanisms, maintain that share; others are trying to migrate patients on to the next generation of innovation. I think at the end of the day, those companies that are focused on innovation should focus on innovation, and when a drug comes to the end of its life, recognize that and also recognize the important role that generics and biosimilars do play in creating a sustainable marketplace for both new and old medicines.

There’s a new factor here in the equation, and that of course, is the Inflation Reduction Act (IRA) as it applies to the US, where we now have this finite period—nine years for small molecules, 13 years for biologics—before a maximum fair price may be determined for your drug by CMS. That's clearly putting more pressure on manufacturers to achieve the return on their investment in innovation within that window, and we know that this is affecting the strategy for companies, both when they introduce their drugs, but then also as they manage the lifecycle, because of the finite duration that they that they have under the IRA.

In the third part of his Pharma Commerce video interview, Murray Aitken, executive director, IQVIA Institute for Human Data Science, explains the strategies that manufacturers should adopt to balance investment in innovation with lifecycle management.

How Pharma Must Evolve in a Competitive Therapeutic Landscape

The report reveals a shift from volume-driven to mix-driven spending, including a move toward more expensive, higher‑value therapies across regions. How should pharma companies revise their market access and pricing models to align with this evolving landscape?

One of the things that we see happening in the global market is the increased use of the 1,000 new drugs that have been launched over the last 20 years. We still have a lot of medicines older than 20 years that are driving volume, particularly in low- and middle-income countries, but also in high-income countries to some extent, but it's that 1,000 novel active substances that have been launched over the last 20 years that are driving a lot of the growth, which is where we see this shift in the mix of drugs being used.

What that means for manufacturers, is that it's a much more competitive environment than it was five, 10, or 20 years ago. There're a lot of other novel drugs out there, so that all comes back to the quality of the clinical evidence, the real-world evidence about the safety and efficacy of the drugs, not only on average for all patients, but for some populations of patients.

Generating that evidence is critically important, and then educating and communicating with healthcare professionals becomes a much more focused and tailored effort than it used to be because of this level of competition. This is where we see digital and AI being incorporated to really be very precise about the messaging that gets delivered to specific healthcare professionals at specific times of the day and in certain settings, so I think these are really driving shift towards better medicines for more patients.

In the second part of his Pharma Commerce video interview, Murray Aitken, executive director, IQVIA Institute for Human Data Science, suggests how pharma companies should revise their market access and pricing models to align with the evolving landscape.

Fixing the Pharma Pricing Puzzle

, LeAnn Boyd, PharmD, Liviniti’s founder and CEO, discusses the deeper, systemic issues behind rising healthcare and drug costs that are not fully addressed by the MFN (Most-Favored Nation) executive order. She acknowledges that the healthcare landscape has seen incredible advancements in therapies that significantly improve patient outcomes and well-being. As more people utilize pharmacy benefits—rising from 50% to around 70% in recent years—overall drug spending has naturally increased. While greater access to treatments is positive, Boyd emphasizes that this doesn't fully explain the sharp rise in costs.

She views the MFN executive order as a useful initial step—a spark that brings attention to the issue, especially considering that the US pays significantly more for medications than other countries. However, Boyd expresses concern that the order lacks the depth needed to address all the systemic contributors to high drug prices.

A key issue, she argues, lies in the misaligned incentives within the drug pricing ecosystem. Many stakeholders, such as pharmacy benefit managers (PBMs) and other intermediaries, have compensation structures that are tied to the list price of medications. This creates a perverse incentive to favor higher-priced drugs, as higher costs directly translate into greater profits for these players. As long as stakeholders are financially rewarded based on drug prices rather than patient value or outcomes, upward pressure on prices will persist. Boyd concludes that unless these incentive structures are realigned to reflect value-based compensation, rather than price-driven earnings, any reform—like the MFN rule—will fall short of creating lasting change in the healthcare cost landscape.

Boyd also comments on how PBMs will be significantly impacted by the EO; why PBMs that operate on 

lat admin fee model rather than rebates create more transparency and value for both payers and patients; what meaningful drug pricing reform looks like in her view; and much more.

What would meaningful drug pricing reform look like to you?

In the final part of her Pharma Commerce video interview, LeAnn Boyd, Liviniti’s founder and CEO, describes what meaningful drug pricing reform looks like to her. 

Pricing

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