Are Big Changes on the Way in Market Access?

While the Biden administration’s Build Back Better Act continues to be debated and revised on Capitol Hill in the hopes of finding a version that will pass, one component that is expected to remain is drug pricing reform. Now, government officials are always talking about wanting to lower drug prices, so will this be the time that they actually deliver on that goal? And if so, what will this mean for our industry?

Well, in the words of AJ Ally and Matt Berman from Milliman, the legislation being discussed includes “proposals that could drive some of the most material changes in drug pricing in the history of the Medicare Parts B and D programs.” In their article, they dig into the changes that would result from the government’s ability to negotiate drug prices for Medicare, an inflation rebate that could take effect as early as 2023, and a plan to increase reimbursement for biosimilars for a temporary five-year period. You will want to be aware of all of these changes should Build Back Better pass.

But the market access space is undergoing changes even without shifts in policy as the growth in specialty products has created complicated payer coverage due to a need to better understand some of these emerging therapies. Fortunately, Greg Novello and Nancy Codoner of McCann Health Managed Markets, an IPG Health company, explain ways to uncomplicate this process. In their article, they lay out the key aspects you must consider if you seek optimal coverage for your specialty product and how to help providers navigate the administrative hurdles to make sure patients can actually access these medications.

Speaking of patient access, our Think Tank features 10 industry experts who offer insights into ways pharma companies can improve their patient support programs. This goes beyond making drugs more affordable through copay programs by offering other solutions and services that makes it easier on patients to get their medications in a timely manner.

So yes, the market access space may be complicated. It can be a struggle for patients, providers, and even some in the industry to completely grasp its complexities. But with the strategies provided in this issue, you can better understand what is required to get medications into the hands of the patients who need them. That is the ultimate goal after all.

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