How rebates can misalign incentives

In Episode 494 of Relentless Health Value, host Stacey Richter engages in a detailed discussion with Sarah Emond, CEO of ICER, about the intricate dynamics of pharmaceutical drug pricing. They explore six primary tensions within the current system, including the fair valuation of drugs, the misalignment between drug prices and patient affordability, the disconnect between lifetime drug value and short-term insurance assessments, and the challenge of integrating societal and individual perceptions of value.

Emond and Richter also discuss potential solutions, emphasizing the need for value-based pricing models free from financial conflicts of interest. They highlight the critical role of payers, PBMs, and drug manufacturers in aligning pricing with value to improve patient access and reduce overall healthcare costs.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP494

🔗 Visit our sponsor Payerset https://payerset.com

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe

🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe

🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b

📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue

=== CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/

08:18 Why list prices are a lie.

10:59 How does the rebate model sometimes get in the way of paying for value?

12:50 Bonus clip with Sarah Emond.

13:14 EP491 with Elizabeth Mitchell.

13:20 EP490 and EP492 with Shane Cerone and Sam Flanders, MD.

14:37 The tension that is created between affordability and adherence.

15:03 When cost sharing makes sense in pharmaceutical drug pricing.

17:26 INBW42 with Stacey on moral hazard.

18:53 How GLP-1s are "wildly cost effective."

21:32 Why the sticker shock on cost-effective drugs is a failure in the system for paying for value.

22:38 ICER's report on GLP-1s.

26:59 EP385 with Dan Mendelson.

28:57 How employers and payers can have a value assessment approach and a health insurance system that allows access to cost-effective drugs.

29:48 How cost-effective prices are calculated.

31:55 One of the core value underpinnings for value assessment of drugs.

34:54 Why manufacturers and pharmacy benefit managers should work together more by referencing something like an ICER report.

36:55 EP426 with Nina Lathia, RPh, MSc, PhD.

38:21 "We can make different choices."