EP216: Getting Rid of Drug Rebates, With Chris Sloan From Avalere Health
Relentless Health Value™February 21, 2019
216
34:1246.98 MB

EP216: Getting Rid of Drug Rebates, With Chris Sloan From Avalere Health

Chris Sloan is an associate principal at Avalere Health, a Washington, DC–based nonpartisan consulting firm. He advises a number of clients—including pharmaceutical manufacturers, health plans, providers, and patient groups—on key policy issues facing the health care industry. His particular areas of expertise include drug pricing, the Affordable Care Act, generics, and biosimilars. Additionally, Chris is a recognized expert in the health care policy issues facing people living with HIV/AIDS and multiple sclerosis. 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 such as the Wall Street Journal, the New York Times, Politico, Vox, and others. He has a BBA degree in economics and marketing from the College of William and Mary.


01:12 The HHS proposal.
02:29 “Rebates are a really big part of Medicaid Part D.”
02:45 What the “follow the dollar” looks like in this scenario.
04:10 How rebates between PBMs and manufacturers work, and how list prices play into this.
05:26 How this system can hurt the patient, and how this new proposal works to change that.
06:37 Pricing a product as a PBM.
08:04 The total dollar value of PBM rebates.
11:24 Do we know how much PBMs are making in incentives?
14:08 Are PBMs helping or hurting the process?
17:13 Why pharmaceutical managers may be more compelled to raise their prices thanks to large PBMs.
18:10 Perverse incentives in the system.
18:55 “At the end of the day, PBMs are still going to be employed by health plans.”
20:29 How a new model is combating the perverse incentive that raises prices for patients.
23:45 The trade-off involving premium prices in this new proposal.
26:13 “We’re not talking astoundingly large amounts of money.”
26:46 Why PBMs and health plans are against this proposal.
27:37 Why Pharma is for this.
29:11 The perverse incentives for health plans.
31:00 The benefit of Part D.
31:46 The advantage of huge rebates.

digital,healthcare,pharma,tech,avalere health,drug rebates,hhs,pbm,

Recent Episodes

Encore! EP384: How Shareholders Impact Carrier Behavior, Exactly and Specifically, With Wendell Potter
February 06, 202535:0132.05 MB

Encore! EP384: How Shareholders Impact Carrier Behavior, Exactly and Specifically, With Wendell Potter

I am drowning in all things Q1 right now. So, this week we’re going with an encore. But this is a great show to go back and reflect upon, as it’s about carriers and how shareholders impact the actions of said carriers. For a full transcript of this episode, click here . If you enjoy this podcast, b...

EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD
January 30, 2025
462
33:3430.73 MB

EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD

Hello, Tribe. I hope everyone is holding up in this Q1 where there is so much going on. I feel like I’m juggling 10 plates while running on a treadmill that keeps stopping and starting at random intervals. How you doing? For a full transcript of this episode, click here . If you enjoy this podcast,...

INBW42: A Philosophical Rabbit Hole of Considerations for Plan Sponsors and Others
January 23, 202527:3925.31 MB

INBW42: A Philosophical Rabbit Hole of Considerations for Plan Sponsors and Others

There have been two episodes lately that have sent me down a rabbit hole that I wanted to bring to your attention. Now, disclaimer: I know you people; you’re busy. You listen on average to, like, 26 minutes of any given episode. So, yeah … look at me being self-aware. I say all this to say welcome ...

EP461: Pick Only One, Plan Sponsors: Do You Want to Control GLP-1 Volume or Control GLP-1 Unit Cost? With Chris Crawford of RxSaveCard
January 16, 2025
461
22:4220.78 MB

EP461: Pick Only One, Plan Sponsors: Do You Want to Control GLP-1 Volume or Control GLP-1 Unit Cost? With Chris Crawford of RxSaveCard

This episode with Chris Crawford, CEO of RxSaveCard, is not about the when, why, or how of GLP-1s for weight loss or best-practice prescribing; and we do not wade into anything about lifestyle changes or who is adherent or clinical considerations and needed support. There are a plethora of shows on...

EP460: Rushika Fernandopulle, MD’s Theory of Change Starts With Status Quo Healthcare
January 09, 2025
460
41:0437.6 MB

EP460: Rushika Fernandopulle, MD’s Theory of Change Starts With Status Quo Healthcare

This is one of those episodes where we consider top-line strategic imperatives and key drivers. I thought there was no better person to do this with than Rushika Fernandopulle, MD, who, in case you were unaware, was the founder of Iora Health, an advanced primary care group that was sold to One Med...

EP459: Cost Containment by Co-Pay Maximizer or Co-Pay Accumulator: Points to Ponder, With Bill Sarraille
January 02, 2025
459
39:4736.41 MB

EP459: Cost Containment by Co-Pay Maximizer or Co-Pay Accumulator: Points to Ponder, With Bill Sarraille

If you have zero clue what co-pay maximizers and/or co-pay accumulators are and the financial incentives involved for PBMs (pharmacy benefit managers) and plan sponsors here, after you’re done listening to this episode, go back and listen to the show with Joey Dizenhouse ( EP423 ). Also, the episod...

INBW41: End-of-Year Wrap-Up and My Personal Charter Encore: Where the Rubber Hits the Road
December 26, 202425:5223.67 MB

INBW41: End-of-Year Wrap-Up and My Personal Charter Encore: Where the Rubber Hits the Road

Okay, so, we’re gonna go with personal charter. Just, yeah, given everything going on right now, yeah. It is a charter, not a manifesto. Because of the end-of-the-year status of this episode, I just want to kick this off by giving a big thank you to everyone listening. But this isn’t a thank you fo...

Listen and Follow

Sponsored by Aventria Health Group
©2025 BD Bridges LLC. All Rights Reserved.