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S4, Ep 1- On the Cusp of New Drug Pricing Paradigm

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We may be on the verge of an enormous shift in how drug prices are set. It’s been led by a dramatic decline in insulin prices, but it’s spreading to other brand drugs as well.

Join our hosts for the first episode of our 4th season as they dive head-first into this important topic. They’ll discuss how this new paradigm is the unintended but welcome result of legislative, regulatory, and market pressures exerted on the biopharmaceutical industry.

Among the highlights in this episode:

1:14: Dr. Popovian, Chief Science Policy Officer at GHLF, tells us about an 85% discount on the HUMIRA biosimilar that has entered the marketplace

1:55: There have been major shifts in the drug pricing paradigm

2:25: Manufacturers of insulin in the U.S. significantly dropped their prices, which will be capped at $35, representing almost an 80% reduction in price

3:10: These pricing shifts aren’t just limited to insulin as we have seen other brand drugs selling directly to consumers at discounted prices in response to significant marketplace pressure

4:00: 4 factors are contributing to drug manufacturers rethinking of pricing models:

1) Litigation and legislative pressure regarding insulin at the state and federal levels

2) The Inflation Reduction Act has wide-ranging implications on drug pricing

3) The removal of the cap for average manufacturer price for Medicaid rebates

4) FTC and Congressional investigations into pricing practices

6:54: PBMs (Pharmacy Benefit Managers) favor rebate contracting, which leads to higher drug prices by increasing kickbacks and despite passing on some of the benefits to employers or plan sponsors, PBMs keep a significant portion of the rebates and fees, causing higher prices to primarily benefit them

9:02: It’s not limited to insulin – other brand products are being sold directly to consumers with success

9:33: The retail biosimilar market is rapidly evolving, especially with the introduction of biosimilars competing against Humira. For example, the biopharma company Coherus recently set a price ceiling for its Humira biosimilar by selling it directly at an 85% discount through a cost-plus pharmacy

11:27: The biggest losers from lower list prices are PBMs, as they will no longer receive significant rebates. Patients are the biggest winners, as they will experience substantial savings when paying deductibles or coinsurance based on the lower retail prices of medications

12:52: Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF, discusses how legislative, regulatory, and market pressures are shaking up the way drugs are priced in the United States

13:23: Dr. Popovian shares some final thoughts

Are we on the cusp of a new drug pricing paradigm?” - Full article available via the link below:
https://progressivepolicyinstitute.medium.com/are-we-on-the-cusp-of-a-new-drug-pricing-paradigm-fdf611c009b3

Contact Our Hosts

Dr. Robert Popovian, Chief Science Policy Officer at GHLF: rpopovian@ghlf.org

Conner Mertens, Patient Advocate and Community Outreach Manager at GHLF: cmertens@ghlf.org

We want to hear what you think. Send your comments, or a video or audio clip of yourself, to healthcarematters@ghlf.org

Listen to all episodes of Healthcare Matters on our website or on your favorite podcast channel.

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