In this episode, we explore the evolution and future of the Pharmacy Benefit Management (PBM) industry with insights from two seasoned pharma managed care executives. We discuss the early role of PBMs, their acquisition by pharmaceutical companies, and subsequent industry consolidation. We examine how vertical integration of the PBMs transformed their business model, including the restricted formularies that gave rise to rebates. We also address evolving PBM-manufacturer relationships, the effects of public scrutiny, and predictions for key trends. Join us for a comprehensive look at the past, present, and future of PBMs, focusing on the changes needed to better serve patients.

Steve Stefano, Managing Director, ReprizioRx

Steve.Stefano@repriziorx.com

Bill Leonard, Managing Director, ReprizioRX

wjl@repriziorx.com

ReprizioRX

PBMs

IPA model HMO

Medco

Metro Containment Services

Medicare Catastrophic Coverage Act of 1988

Merck

SmithKline Beecham

Eli Lilly

340B

NDC blocks

Group Purchasing Organizations (GPOs)

Medicare

United Healthcare

FTC

CostPlusDrugs

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In this episode, we dive into the pharmaceutical industry's research and drug development side and the real threat that today’s access and affordability challenges and policies pose to innovation. While innovation often starts in universities with government support, biotech, and pharma companies take on the tough, costly job of clinical trials, development, and approval of new drugs. Investment dollars are limited, only the most promising projects get funded, with an expectation there will be a return. However, our current drug payment process and policies like the IRA have added new considerations for investors, risking fewer new drugs being developed. Without changes, patients could face the closing of our nation's medicine cabinet, with fewer new treatments available. This would be an outcome that would be catastrophic for all of us.

Erin Mistry, EVP and Chief Commercial Officer, Cormedix, Inc.

Imran Nasrullah, JD., formerly VP & US Head of BD&L at Bayer, and now Founder, SNAP Life Sciences

Research and development (R&D)

FDA

CF Foundation

Vertex

NIH

AMR (antimicrobial resistance)

The Pasteur Act

HIV

Malaria

Flagship Pioneering Launches Metaphore Biotechnologies to Unlock the Therapeutic Potential of Biomimicry

Novo Nordisk Bets Up to $600 Million on Ozempic 2.0. Here's Why the Stock Is a Buy.

Genentech

Genzyme (Now Sanofi)

Medicare

IRA (Inflation Reduction Act)

COVID-19

Questions or comments?
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This is the second of two episodes dedicated to Asembia’s AXS24 Summit, where we were honored to be a media partner. In this episode, we learn from Sarah Butler, Chief Commercial Officer of ADVI Health and Lindsay Greenleaf, JD, MBA, Head of Federal and State Policy for ADVI Health how the 2024 election will impact patient access and affordability. Umar Afridi, Founder and CEO of Foundation Health, summarizes his session, From Opaque to Transparent: Transforming the Way We Pay for Drugs. Finally, we get a few minutes with Joe Boswell, the President of ACCESS Forum, leading an effort to create a network for market access professionals.

ADVI:
Sarah Butler (Chief Commercial Officer)
Lindsey Greenleaf (Consulting and Government Affairs Head)
R&D
Inflation Reduction Act
NCCN Compendia
Part D
CMS
Pharmacy Benefit Managers (PBMs)
Part B
FTC and Office of Inspector General (IG)
FTC's Section 6B study
Foundation Health:Umar Afridi, Founder and CEO
Session: "From Opaque to Transparent: Transforming the Way We Pay for Drugs."
Pharmacy Benefit Managers (PBMs)
Truepill
API platforms
International Access Professional Society:Joe Boswell. President
GenMAV
Asembia