Not gonna give much of an introduction here because this is a short bonus level set, but I did just wanna call everyone's attention to the "arms race" created by our status quo purchasing and selling of many things, pharmaceuticals included.
For a full transcript of this episode, click here.
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For example, raise the list price of a drug to maximize rebates, because the higher the list, the bigger the discount you can give, which then exacerbates patient affordability because coinsurance is often based on list price. But then Pharma starts offering co-pay cards, which messes up the whole PBM (pharmacy benefit manager) plan to drive patients to their highest-rebate products (ie, the most profitable products).
So then maximizers and accumulators enter the chat, and prior auths ramp up because plans start having to raise premiums after enough 340B drugs with high lists and no rebates, and then there's no cost containment and raise deductibles and around and around we go.
Meanwhile, is this drug fundamentally worth the list price or even the net price? Is it an effective drug? What's the right price to be paying for this drug? Should be the operative question, right? Just like what's the quality and appropriateness of any medical service? Maybe we should just quit it and just pay for value.
And with that, let me introduce Sarah Emond, CEO of ICER (Institute for Clinical and Economic Review), and I will let Sarah tell the rest of the story.
Also mentioned in this episode are Institute for Clinical and Economic Review (ICER); Cora Opsahl; 32 BJ Health Fund; Payerset; Aventria Health Group; Dea Belazi, PharmD, MPH; and Tom Nash.
For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.
You can learn more at ICER.org and follow Sarah on LinkedIn.
Sarah K. Emond, MPP, is president and chief executive officer of the Institute for Clinical and Economic Review (ICER), a leading nonprofit health policy research organization, with 25 years of experience in the business and policy of healthcare. She joined ICER in 2009 as its first chief operating officer and third employee and has worked to grow the organization's approach, scope, and impact over the years.
Prior to joining ICER, Sarah spent time as a communications consultant, with six years in the corporate communications and investor relations department at a commercial-stage biopharmaceutical company and several years with a healthcare communications firm. Sarah began her healthcare career in clinical research at Beth Israel Deaconess Medical Center in Boston.
A graduate of the Heller School for Social Policy and Management at Brandeis University, Sarah holds a Master of Public Policy degree with a concentration in health policy. Sarah also received a bachelor's degree in biological sciences from Smith College. Sarah speaks frequently at national conferences on the topics of prescription drug pricing policy, comparative effectiveness research, and value-based healthcare.
02:28 What is ICER?
02:47 What does the Institute for Clinical and Economic Review do?
05:09 The importance of still showing up, even when others don't understand or disagree.
06:51 EP293 ("Game Theory Gone Wild") with Dea Belazi, PharmD, MPH.
09:04 Why it's important to think about population health and how our choices impact affordability for everyone.
Recent past interviews:
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Stacey Richter (INBW43), Olivia Ross (Take Two: EP240), John Quinn, Dr Sam Flanders and Shane Cerone (EP492), Elizabeth Mitchell (EP491), Shane Cerone and Dr Sam Flanders (Part 1), Dan Greenleaf (Part 2), Dan Greenleaf (Part 1), Mark Cuban and Cora Opsahl