Highlights from Asembia Day 1, Message Testing for Pharma

Asembia24: Insights from Day One

Valuate’s Kimberly Tsai is at Asembia24 and files this report from the first day:

A lot of pulled threads from last week’s AMCP Annual, as well as some new learnings to help paint the fuller picture.

Key trends to monitor in the CGT and rare disease space:

• The booming category of self-insured employers (the TPA/stop-loss market is projected to grow to $800 billion by 2030)
• SPs taking on restrictive management tactics (79% of SPs are reported to be using an NDA block)
• Increased awareness that patient eligibility is expanding among CGT and rare disease products – rare disease is not so rare anymore
• Expect new demand for more holistic care (think clinical management on top of bread-and-butter distribution and access services) to produce greater value that matches these complex patient journeys

The Inflation Reduction Act

While many aspects of program rollout (namely, drug price negotiation and Part D benefit redesign) remain uncertain, hard data is starting to emerge that provides some certainty to the unintended consequences we’ve been speculating about over the past year:

• Most payers are planning to react to higher financial liability through mechanisms like narrower formularies (73%), increase in utilization for specialty products (93%) and negotiating for higher rebate (75%)*
• While OOP smoothing via the Medicare Prescription Payment Plan will benefit many Part D beneficiaries, a significant proportion will still be left in the dust – such as the 75% of Medicare beneficiaries that have difficulty paying $2,000 to begin with, and the 77% that do not know about the OOP cap (especially problematic for an opt-in program)
• As far as the Part D benefit redesign goes, manufacturers play a key role in raising awareness and proactivity among patients and providers to help drive greater participation
• A lot of compelling words and phrases being used to describe the state of our healthcare system today - standouts include “chaotic change,” “uncertainty,” and “crisis.”
• At the same time there is a lot of hope that this era of tumult will give rise to incredible innovations, of which we’re already starting to see signs of through successful case studies of alternative payment and contracting models, integration of digital solutions and AI (not just a buzzword!), and execution of value-based models that are bringing the focus back to clinical outcomes (particularly evidenced by the exciting collaboration between Takeda and Optum).

*Presented as part of a series of data from Xcenda’s “Managed Care Network Survey,” to be officially unveiled in the coming months.

New Episode of The IDI Podcast

Listen to Valuate’s Alex Mindlin discuss message testing for pharma and market access:

On Apple Podcasts: https://podcasts.apple.com/us/podcast/message-testing-and-market-access/id1630221502?i=1000654126467

On Spotify: https://open.spotify.com/episode/0LARZyCNjOfSNxDcw5SQMH

Medicaid News and Analysis

The cap on Medicaid rebates sunsets this year and the change has the potential to significantly affect gross to net and reduce profitability for pharma.

Read our POV to learn how the Medicaid AMP rebate cap removal will affect market access: