Encore! EP216: How Medicare Part D Plans Became Addicted to Drug Rebates, With Chris Sloan From Avalere Health
Relentless Health Value™December 31, 2020
216
31:4443.57 MB

Encore! EP216: How Medicare Part D Plans Became Addicted to Drug Rebates, With Chris Sloan From Avalere Health

Alex Azar, who is the current Health and Human Services (HHS) secretary (until January 21 anyway), came out with a reboot of the proposal that effectively halts the practice of pharma manufacturers paying rebates to Part D plans. This reboot is supposed to go into effect on 1/1/2022. But this podcast is less about this may-or-may-not-actually-happen rule and is more about the actual impact of removing drug rebates within this unintuitively constructed health care system of ours.

Should rebates go away, it’s actually a big deal that fundamentally could upend the heretofore-not-transparent messy middle of drug pricing. I’ll let Chris Sloan, associate principal over at Avalere Health, explain. Spoiler alert: The impact of killing pharma rebates to plans and PBMs (pharmacy benefit managers)? Bottom line, everybody’s insurance premiums go up in the current model when rebates go away.

A few episodes from now, I’m talking with Ge Bai about why this is a suboptimal and not forgone conclusion. But this is what we’ve got going on right now. So, look for EP306 coming up for more on that.

You can learn more at avalere.com.  

Chris Sloan, associate principal at Avalere, advises a number of clients—including pharmaceutical manufacturers, health plans, providers, and patient groups—on key policy issues facing the health care industry. Chris’s economic analyses of key policy proposals and issues, including drug pricing and the repeal and replace efforts around the Affordable Care Act, have been featured in a wide range of publications, including the Wall Street Journal, the New York Times, the Washington Post, Politico, Axios, and Vox.


02:35 “Rebates are a really big part of Medicare Part D.”
02:49 What the “follow the dollar” looks like in this scenario.
04:14 How rebates between PBMs and manufacturers work, and how list prices play into this.
05:31 How this system can hurt the patient, and how this new proposal works to change that.
06:42 Pricing a product as a PBM.
08:06 The total dollar value of PBM rebates.
10:50 Do we know how much PBMs are making in incentives?
13:29 Are PBMs helping or hurting the process?
16:18 Why pharmaceutical manufacturers may be more compelled to raise their prices thanks to large PBMs.
17:13 Perverse incentives in the system.
17:57 “At the end of the day, PBMs are still going to be employed by health plans.”
18:56 How a new model is combating the perverse incentive that raises prices for patients.
22:11 The trade-off involving premium prices in this new proposal.
24:38 “We’re not talking astoundingly large amounts of money.”
25:12 Why PBMs and health plans are against this proposal.
26:02 Why Pharma is for this.
26:51 The perverse incentives for health plans.
28:39 The benefit of Part D.
29:25 The advantage of huge rebates.

You can learn more at avalere.com.  

Medicare,healthtech,pharma,avalere,healthcare prices,drug rebates,pbm,

Recent Episodes

EP455: A Leadership Blueprint for Measurably Better Care, With Beau Raymond, MD
October 31, 2024
455
38:4535.47 MB

EP455: A Leadership Blueprint for Measurably Better Care, With Beau Raymond, MD

A rate critical to attain better care for patients, I’m gonna say, is enlightened leadership—maybe dyad leadership—at a clinical organization. I am saying this because without enlightened leaders, it’d be harder to build from the blueprint that Beau Raymond, MD, talks about today on the show. For a...

EP454: How the Particle v Epic Lawsuit Impacts Plan Sponsors and Public Health Trying to Get Data, With Brendan Keeler
October 24, 2024
454
34:5431.95 MB

EP454: How the Particle v Epic Lawsuit Impacts Plan Sponsors and Public Health Trying to Get Data, With Brendan Keeler

You know why I’m interested in the Particle v Epic EHR (electronic health record) systems lawsuit? It’s because … data. Say I’m thinking about this like, say, a plan sponsor and I want data so I can do better population health or do care navigation to help my members avoid downstream bad things or ...

EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank
October 17, 2024
453
37:0033.87 MB

EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank

TPA stands for third-party administrator. RFP stands for request for proposal. I’m kicking off the show today with a review that we got recently on Apple Podcasts, and not just because it’s a really nice review. It’s because it’s relevant on about nine levels to the show today with Claire Brockbank...

EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl
October 10, 2024
452
39:4836.42 MB

EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl

Last time Cora Opsahl was on the show, Michelle Bernabe, RN, KAT, wrote a comment on LinkedIn I thought encapsulated the gist of it all so well. She wrote, “[Cora] first became a mentor/ally through Relentless Health Value episode 372 . … It opened a doorway to a whole group of very relentless peop...

Spotlight Episode: Oncology Side Effect Management in the Real World, With Dan Nardi From Reimagine Care
October 03, 202419:0717.5 MB

Spotlight Episode: Oncology Side Effect Management in the Real World, With Dan Nardi From Reimagine Care

Right out of the gate here, I wanted to thank Reimagine Care for sponsoring this episode. It’s kind of a breath of fresh air, honestly, to have someone reach out not only with an interesting pitch for a show but also with an offer to help out financially. For a full transcript of this episode, clic...

EP451: Hey, Let’s Not Talk About Artificial Intelligence, With Spencer Dorn, MD, MPH, MHA
September 26, 2024
451
12:3911.58 MB

EP451: Hey, Let’s Not Talk About Artificial Intelligence, With Spencer Dorn, MD, MPH, MHA

Before we kick in to the show today, I just want to make two points. Here’s the first point. Together, we can do it. No one said transforming healthcare and elevating patients over profits would be easy. And it is not. It’s really, really hard. I just want to say thanks for all that you have accomp...

EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CGMA, CMA, CFM
September 19, 2024
450
34:4531.8 MB

EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CGMA, CMA, CFM

Yeah, I made a meme for the show with Marilyn Bartlett. My very first meme ever. What carriers try to convince you is necessary vs a CPA with a spreadsheet. In this meme, I picture that Olympic silver medalist shooter from Turkey who showed up in a T-shirt and his hand in his pocket versus the ot...

Listen and Follow

Sponsored by Aventria Health Group
©2024 BD Bridges LLC. All Rights Reserved.