In this market access update, Bettina shares her key trends and insights from the event.
“The2023 AMCP (Academy of Managed Care Pharmacy)conference was truly special to attend this year,” says Bettina Kuehl, Project Manager, PRMA Consulting. “With healthcare and policy changes rapidly evolving in the US it was valuable to meet and greet with top industry leaders in the managed care pharmacy space.”
Pharmaceutical drug pricing trends
Increasing cost pressure in the market due to increasingly high-cost treatment launches.
Consumer prices rose 6.5% from December 2021 to December 2022. Food prices increased 10.4%.iDespite inflation being up, pharmaceutical drug prices have surprisingly flattened.
The Inflation Reduction Act (IRA) necessitates new considerations across the full product lifecycle for Medicare negotiation, inflation rebates, and Part D benefit redesign.
Fewer drug launches in 2022 compared with recent years but oncology, dermatology, and infectious disease therapies are leading the way.
Specialty growth outpaces traditional growth now, accounting for 51% market share of total non-discounted spend.ii
Oncology is forecasted to grow by 13-16% CAGR and immunology is forecasted to grow by 3–6 CAGR% through 2027.iii
Potential for up to 50 generic drug approvals in 2023.iv
Biosimilars are gaining momentum in the marketplace driving new biosimilar launches in the next few years
Huge headwinds and growth across auto-immune and oncology driving specialty medicines.
A shift in pharmaceuticals from brand and generics to more complex and specialty products across cell and gene therapies, biosimilars, orphan and rare diseases, vaccines, etc.
New therapies and advancement driving growth of neurology (e.g., Alzheimer’s disease, Parkinson’s, rare diseases, and migraine).
Biotherapeutics to significantly prosper over the next 5 years (e.g., cell, gene, and RNA therapies).
Cardiovascular diseases will continue to make up a big portion of spending over the next 5 years, with obesity leading the way despite decline in diabetes growth.v
Most of the future opportunities will be in biosimilars.
Regulatory and legislative changes
Bernie Sanders has introduced the Medicare for All Act of 2022 with 14 colleagues in the Senate.vi Bernie Sanders sits as Chair in the Senate of Health, and is expected to drive Medicare changes and single payer healthcare.
Increasing focus on lowering unaffordable healthcare costs, led by Brett Guthrie, Chair of House of Energy. The legislative incentives have been introduced to drive transparency and competition in the healthcare space.vii
The Congress is split, which will allow for more legislative opportunities/bipartisan legislation.
IRA to pressure pharmaceutical drug manufacturing, which might result in inflation penalties and price negotiations.
As the Biden administration releases additional details about IRA policies, including the recent Center for Medicare and Medicaid Services (CMS) guidance on Medicare negotiation and maximum fair price (MFP), understanding these policies is critical as stakeholders prepare their business strategies and identify opportunities to shape policy development.
Payer conversations from the AMCP conference
The patient as a payer continues to get a louder voice in the marketplace. As new products become more expensive, they are increasingly being abandoned by patients.
The role of the pharmacist is growing rapidly.
There is an ongoing debate on formulary contracts between payers, as providers and insurance companies strive to provide more affordable option to patients.
The payer mix is changing rapidly as the question about who pays continues to gain momentum in public debates and conversations, and who pays the price difference remains a dilemma (e.g., the patient, the pharmacy, the provider, or the payer?).
New models are emerging for VBAs vs traditional “warranty”, ushering in new innovative approaches and a paradigm shift for payers.
Payers have experienced an increase in pressure on health systems, insurers and pharmaceuticals due to the rise of general costs as the pharmaceutical market is becoming increasingly complex
For many high-cost medications (e.g., specialty medications, medicines for rare diseases, orphan drugs), the challenge remains to determine the true clinical value of these products, which causes difficulties when assigning coverage criteria.
We imagine a healthier world and create the connections to make it happen
With healthcare and policy changes rapidly evolving in the US, it is important to be at the forefront of the changing market landscape to support the appropriate use of medications, enhance patient and population health outcomes, and optimize healthcare resources.
There are lots of exciting opportunities ahead for clients working with our experts in pricing, access, value, and evidence. For a confidential conversation please get in touch.
Share this article
Cell and gene therapy insight: navigating the market access landscape
Privacy & Cookies Policy
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.