Milliman Value and Access Awareness

In honor of?Women's History Month, we're spotlighting trailblazing women transforming the future of healthcare! Tune into this episode of Milliman’s Critical Point podcast, featuring MVAA’s clinical pharmacist Melanie Kuester, along with Kristin Niakan?and Brittany Schock as they delve into: ?? The revolutionary world of cell and gene therapies (CGTs) ?? The significant impact of CGTs on state Medicaid agencies ?? Strategies that states are adopting to predict utilization and manage the high costs of these treatments Don't miss this insightful discussion! ?? Listen now: https://lnkd.in/gWzXywFR #WomensHistory #CellAndGeneTherapy #MarketAccess #Medicaid

Healthcare transparency and reform are continually debated. We explored the impacts of the Federal Trade Commission’s (FTC) investigative report on Pharmacy Benefit Managers (PBMs). Here are 5 key takeaways impacting Pharmaceutical Manufacturers, Health Insurers, Specialty and Retail Pharmacies: 1.?????Specialty Pharmacies:?PBMs may require patients to fill specialty prescriptions at PBM-affiliated pharmacies, creating access challenges. With FTC scrutiny, there may be fewer drugs classified as "specialty," opening doors for independent specialty pharmacies. 2.?????Retail Pharmacies:?Independent pharmacies face hurdles due to PBMs' network practices and unpredictable reimbursements. Potential reforms could level the playing field, enhancing transparency and fair reimbursement, much like Medicare Part D's "any willing pharmacy" model. ? 3.?????Generics and Biosimilars:?PBMs' private labeling and formulary decisions have influenced market dynamics, especially for biosimilars like adalimumab. Future reforms might reduce barriers, promote biosimilar adoption, and lower costs for patients. 4.?????Rebate Aggregators/GPOs:?The role of rebate group purchasing organizations adds complexity to drug pricing. Increased transparency could lead manufacturers to reevaluate pricing, rebates, and contracting strategies. ? 5.?????PBM-Affiliated Health Insurers:?Higher reimbursements from affiliated insurers to PBM-owned pharmacies raise concerns about medical loss ratio (MLR) calculations. Regulatory focus may prompt changes in reimbursement models affecting plan sponsors and manufacturers. ???Read more about how these developments could reshape strategies for patient access to therapeutics and impact the future of pharmacy benefit management. https://lnkd.in/gdmMEtU5 #LifeSciences #Biopharma #MarketAccess #PBM

Today, we are excited to launch Milliman Value and Access Awareness (MVAA)! ?? For over 15 years, we have worked closely with life science partners to help healthcare providers navigate the complexities of insurance coverage. In our experience, we have observed how coverage insights can support better decision-making and enhance patient access to medications. We equip life science organizations with the tools needed to help healthcare providers better understand: ?? Payer Policies ?? Reimbursement Pathways ?? Financial Considerations ?? Local Coverage By bridging the gap between coverage and care, we reduce patient barriers to access some of the most innovative products on the market. If you're interested in discovering how to enhance value in life science market access, follow us to learn more! #LifeSciences #Biopharma #MarketAccess #Milliman