Here’s one fact of life that’s always true: It will always be the desire of big vested interests to maintain and stick with the status quo. This applies to all of the various parties in the drug supply chain as much as it does to any other industry. So, here’s the $106-billion-a-year question: In 2019 or 2020, will all of the drug pricing proposals and legislature popping up all over the place in Washington and in some states right now—will they all just simply blow over? Is it the case that Big Pharma and pharmacy benefit managers (PBMs) and insurance carriers are well girded enough to withstand these various efforts to undermine their revenue streams—at least at some level?
But let’s start at the beginning. You may be wondering what exactly is going on right now legislatively and with various proposals. It’s very difficult to keep track of it all. And what are pharma companies and PBMs and insurers mulling over as they contemplate their strategies to maintain their current level of control and keep their shareholders happy? Never fear. In this health care podcast, I speak with Josh LaRosa from Wynne Health Group. He sets us straight and gets us up to speed.
You can learn more at wynnehealth.com.
Josh LaRosa, MPP, joined the Wynne Health Group in November 2018, bringing with him over three years of federal health care policy consulting experience. The majority of his experience in the federal consulting space has been with the Centers for Medicare and Medicaid Services (CMS), and he in particular has worked heavily with the agency’s Center for Medicare and Medicaid Innovation (CMMI).
With CMMI, Josh worked to implement, monitor, and spread learning garnered from the center’s high-profile demonstration projects, most recently including the national primary care redesign effort, Comprehensive Primary Care Plus (CPC+). Josh has also assisted a multitude of provider organizations participating in CMMI’s Health Care Innovation Awards Round One and Two to implement their innovative health care delivery and payment models. Through such experiences, Josh has been exposed to a wide array of innovations in health care delivery and is deeply interested in how changing provider, patient, and payer incentives can result in a higher-quality and more cost-effective health care delivery system.
Josh holds a Master of Public Policy from the University of Virginia’s Frank Batten School of Leadership and Public Policy, where he had the opportunity to work with a DC-based nonprofit and explore policy options for addressing the behavioral health needs of military and veteran families. Josh also completed his undergraduate studies at the University of Virginia, graduating cum laude with a BA degree in political philosophy, policy, and law.
01:48 This conversation happened at the end of August 2019.
02:32 Are we at an inflection point with health care legislation?
05:10 What obstacles stand in the way of seeing any legislation passed by Congress?
05:51 EP231 with AJ Loicano.
06:14 Most likely to happen and most disruptive among the health care measures being proposed.
09:03 The catastrophic benefit and how it works.
16:34 International Pricing Index Model.
20:12 The two areas that would have the greatest impact on the industry, if they transpire.
21:07 Federal Trade Commission (FTC), PBMs, and drug pricing.
21:46 Mandating PBM contracts, and what it would take at the FTC.
22:27 Bringing transparency to the forefront of PBM contracting.
27:10 Brand manufacturers vs generic manufacturers.
28:05 Breaking down barriers in generic reform.