PCMA celebrates the status quo

By Jeff Berkowitz, Rob O'Brien, and Ryan Walsh

We attended the PCMA Business Forum this week, a celebration of the status quo, market-access wise. The Big Three were a dominant presence; the smaller PBMs with disruptive ambitions were certainly there too. But at least in most of the sessions and hallway discussions we attended, those organizations had at best modest shares-of-voice.

Indeed, there was little talk about either innovations in pricing or business model from the podiums at this year’s event. Instead, the PBM talking points were modest and tactical: 2024 pricing negotiations and Medicare bids, for example. That short-termism disguised, or perhaps accentuated, largely undiscussed concerns around Congressional investigations and pressures to unwind traditional rebate-driven pricing models.

Other longer-term issues were also on attendees’ minds. In the meeting rooms and at lunches and parties manufacturers had plenty of questions, including: ?

• What are the implications of the Inflation Reduction Act? (“Don’t know,” or a shrug, were the most common answers from the payers.)
• ?What about the new value-based contracting approach CMS is suggesting for gene therapies and Medicaid? Will a single negotiator working on behalf of the states to create risk-shares with manufacturers actually accelerate access to these medicines? (That’s one of the topics that will be addressed at RE’s invitation-only meeting in May on the commercialization of gene therapy/gene editing, by the way.)
• And talking about risk-sharing: do warranty models work? What has been learned from the early experiments about their value in improving patient access, addressing payers’ coverage concerns, and limiting the financial risks of contracting (like Medicaid Best Price)?

Answers to these questions are neither simple nor straightforward – and it will take months in some cases to suss out potential implications. As such, perhaps the palpable sense of uncertainty carpeting the J.W. Marriott should have been expected. Change is coming to health care sector. ?When? Who will be most affected? What can – or should – organizations do to prepare and/or respond? None of that did this meeting clear up.

We at Real Endpoints have as many questions as answers – and are happy to discuss both.

#marketaccess #PBMs #drugpricing

Update March 7: This article has been edited to clarify attending companies.