Utah Life Sciences Summit: The Rainbow of Drug Reimbursement

Nov 14, 2019 | Blog, Drug Reimbursement, Insurance, News, Utah Life Sciences Summit

Utah Life Sciences Summit The Rainbow of Drug Reimbursement

Held at the Salt Lake Marriot on November 7th of this year, the Utah Life Sciences Summit was a true pleasure for all those in attendance. Its speakers and presenters were just one of many highlights and included a range of experts and figures from the life sciences and political sectors—from Utah Governor Gary Herbert to the CEO of BioUtah, Kelvyn Cullimore

Participants at the Summit had many presentations to choose from in the three tracks that were provided, each with a focus on regulatory, reimbursement or life sciences topics. TrialSite News attended, in track two, the presentation titled “Rare Drugs to Generics: The Rainbow of Drug Reimbursement.” 

At this particular track, panelists included Alex Keeton, Director of Policy Research and Analytics at BIO; Scott LaGanga, Senior Vice President of PhRMA; Emily Phillips, Executive Director at Pharming Healthcare, Inc.; and Joel White, founder and president of Horizon Government Affairs. Dolly Judge, Vice President of U.S. government affairs for Teva Pharmaceuticals, was the moderator for this track. 


Dolly Judge began with the question: “Are we at a time where the industry could do enough to self-regulate on pricing to preclude or mitigate the need for state or federal legislation?” It’s a tough question, one that could be discussed for days. And although the track was only an hour long, there were many thought-provoking and eye-opening statements.

For example, Emily Phillips provided her perspective on Judge’s question as she explained that 30 years of research and develop went into her company’s life-saving biologic drug. She also mentioned the amount and investment of time and money that come into play in terms of some of the pricing. She poined out the common perception of pharmaceuticals and biologic companies as being greedy manufacturers. “But,” said Phillips, “at the end of the day, everything that we do and the millions we spend on patient support programs or copay programs to make it affordable, the amount of education, the nurses that are out there—I just hope that from a story-telling perceptive, that there is this flip side that there is so much good that we do, so much good we want to do and actually there’s regulations in place that actually limit what we are allowed to do. 

You’d be disappointed being in a reimbursement and patient access roll, there’s things that we would love to be able to help our patients with even more so, without being afraid of potentially having a lawsuit or being fined or stepping out of bounds.”

Many obstacles are in the way for both patients and company officials, and pricing is just one of those. As mentioned by Alex Keeton during this track, “As science has advanced to the point where we have things like cell and gene therapy and single-administration therapies,” it is becoming clear today’s drug pricing model is insufficient for future potentials. It’s important that we realign this sentiment that drug prices are out of control, and redefine what is truly valuable to patients in terms of cost. Because of this, Keeton says, “this leaves us in precarious situation in terms of the impact on the kinds of medicines that can be brought to market.” 

Joel White agreed, saying, “The questions remains—how do we pay for these very desirable but very high-cost type products?” He continued that “The stuff we’re trying to get as a society to cure disease, is probably not going to be developed,” and this is due to regulations and laws limiting pharmaceuticals’ motive to invest in the potentially low rate of return these experimental therapies have. “This is the wrong incentive for the advent of medicine,” Judge reaffirms. 

“The biggest issue in most states right now is a baseline around international reference pricing,” says LaGanga. “The industry has a role to play in self-regulation,” explains LaGanga, “in order to then have it where that business model can survive in the future.” 

Insurance is its own language, and it’s very hard to understand. She poses the question: “Is there more that we could or should be doing to speak more of a common language with the insurers or try to help consumers understand insurance better than they do?”

“It’s not even just knowing insurance,” stated Phillips, “it’s having, as a manufacturer, people with the know-how to help them navigate these coverage challenges.” The devolution in insurance coverage is pushing pharma company’s to have more aggressive in the insurance field—one that supports patients paying less and implements policies to change the current common ground. 

We’re actually had multiple conversations with plans, and large national ones, on value-based arrangements—a lot of them don’t even have the systems to implement the kind of contracts that we’re proposing from a value-based perspective. Tracking outcomes and wellness for patients over time for their membership, and they don’t have the ability to do so. 

“We should have a system that permits these implementations across the board, not just on a case-by-case basis,” says Keeton. 

It’s a long road to haul, with years of work ahead, to get to a place where currents pricing channels operate in a way that benefits patients in need of both current and future medical advancements. Persistence is necessary when fighting for the patients in the insurance world. It will be a continual effort to ensure value-based reimbursement is done in a way to allow for differences in therapeutics areas. Correcting the record is part of that—making sure that we are telling our story and the stories of patients whose lives are being changes by these treatments. 

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