Part D Changes, Oncology Trends, and Data Analytics for Manufacturers
Valuate Health Consultancy
Combining real world experience with advanced analytics and insights to improve market access for all.
How Will the New Part D Benefit Designs Affect Manufacturers?
The drug pricing measures in the new Inflation Reduction Act create a more generous benefit design and will likely increase prescription drug utilization among Medicare beneficiaries, says Jim Kenney, PharmD, a Principal Consultant with Valuate. But what do the Part D benefit design changes mean for pharma?
First, health plans and PBMs will face financial risks with the new design and must focus on managing the benefits for Medicare patients to minimize cost given premium restrictions, anticipated increased prescription volume, and the potential for mandatory coverage of the negotiated drugs if not in line with their current formulary.?
As a result, it is expected that formulary management will increase and could include:
Manufacturers will face pressure to provide increased rebates to cover the expected utilization growth; however, those with drugs that may be selected for negotiation may also risk future maximum fair price challenges with HHS based on their current rebates in the market. This list of products will be identified in 2023 and the initial contracts take effect in 2026; by 2029, there will be 60 negotiated Part B and Part D drugs in the program.
How Manufacturers Should Respond to Part D Changes:
Manufacturers must demonstrate the core value and differentiation of their products from competitors to protect their position and support favorable access on the Medicare Part D formularies.?
The risk of formulary removal and increased utilization management can be mitigated with a strong clinical and financial profile for each drug. This includes:
For fully integrated Medicare Advantage Part D plans (MA-PD), products with the best outcomes will have good success under the new benefit design as a strong health economic story will provide compelling evidence for coverage. ??
MA-PD plans will have the ability to offset some of the pharmacy benefit drug costs with savings on the medical side while the Prescription Drug Plans (PDPs) will need to aggressively manage the pharmacy benefit to remain financially viable and compete with MA-PD plans for beneficiaries.
Read more Inflation Reduction Act analysis at ValuateHealth.com
Takeaways from the ACCC’s National Oncology Conference
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Colleague?John Hennessy?returned from the?Association of Community Cancer Centers (ACCC)?39th National Oncology Conference with three takeaways:
The Enhancing Oncology Model was on everybody’s mind at this year’s conference. Presenters included representatives from the Centers for Medicare and Medicaid Innovation, as well as providers from community and academic settings. “Applicants will be accepting two-sided risk from the beginning of this program, so we can expect both sophisticated and nuanced decision making with regards to formularies and pathways,” Hennessy says.
Provider systems are becoming more flexible regarding oncology care delivery, including payer policies and patient preferences. “Health systems with broad regional coverage recognize that many of their patients will have a difficult time accessing care at their centers for treatment and are adapting their models of care to meet those needs,” Hennessy says.
Recruitment, retention, and professional development were themes that appeared throughout the conference. “Oncology, like other sectors of healthcare, has been impacted by the great resignation,” Hennessy says. “Many practices are struggling with staffing issues, both in the clinical and administrative sides of their business.”
Listen to John Hennessy discuss the Enhancing Oncology Model on The IDI podcast on Apple Podcasts or Spotify:
How Should Manufacturers Approach Data Analytics?
Pharma should take a “backwards design” approach when working with data, says?Jack Timko, Valuate’s Principal, Data Analytics:
“We use that approach because ultimately, we’re in the question-and-answer business,” Timko says on an upcoming episode of The IDI podcast.
“We’re thinking about what you want to know, and we don’t effectively start with any assumptions. We start with: What are we trying to answer? What are we trying to solve for? What’s our hypothesis that we want to test?”
“And from there, let’s find the right data sources,” Timko says. “Let’s apply the right methods. Let’s conduct a rigorous analysis and thorough testing, and then let’s interpret the findings.”
Follow The IDI on Apple Podcasts or Spotify to hear the entire interview with Jack Timko discussing data and data analytics for pharma: