Sara Drake RPh, MPH, MBA

The Inflation Reduction Act is now law and includes provisions that will affect Medicaid programs. Let's talk about it. mercer-government.mercer.com/content/dam/me…

@april_lindquist Yes, absolutely. It's an iterative process and it makes sense for the #Medicaid program to review risk migitation each year in the context of what drugs are in the pipeline. How you manage something like a treatment #HIV is different from you you manage an ultra-orphan drug.

@SaraDrakeRx Do you find that some state Medicaid programs have to adjust their risk mitigation solutions each year considering all the new drugs coming out? #MercerChats

A3: At the same time as presenting clinical opportunity, #GeneTherapy will create financing challenges to employers and state Medicaid programs. Payers will need to explore risk mitigation solutions to align with program and budget goals. #MercerChats

A3: Some private plan sponsors have explored financing models like pay over time for high cost drugs. Challenges in the #Medicaid rebate structure have made similar models challenging to implement. #MercerChats

@samespinosa_mmc @samespinosa_mmc with great challenge comes great opportunity? #MercerChats

A3: One challenge is that the payment innovation always follows the pricing change/increase… #healthcare #Medicaid #MercerChats

@GageGrammer @LisaLint @Mercer_US Under the ACA, BC is supposed to be a covered preventive service with no copay (unless your employer is somehow exempt?). #MercerChats

@LisaLint @Mercer_US But, I'll also call out that my #healthcare won't even cover my BC so lol even generic is expensive in that sense... #MercerChats

@TracyFWatts @TamaraMcCleary We need true #DrugPriceReform that provides value and relief for both patients and payers.

@TamaraMcCleary Also need to keep an eye on legislative activity in the states @TamaraMcCleary - not helping to bring Rx costs down. #MercerChats

A2. The rising cost of #inflation adjusted #drug pricing alone is blowing holes in business and government budgets. Beyond this the next 3-5 years will bring even more effective, yet costly, treatments & cures. Managing cost, as always will be the greatest challenge. #MercerChats

@april_lindquist Absolutely! Risk mitigation solutions for Medicaid programs include risk corridors, risk pools, kick payments, reinsurance, and partial carve-outs. It's important for states to identify and implement the best solution to align with program goals. #MercerChats

@SaraDrakeRx I'd love to hear more about those risk mitigation ideas - maybe another #MercerChats

A3: Speaking of Sovaldi and Hep C @samespinosa_mmc , some #Medicaid programs have been successful with implementation of subscription models for select drug classes such as #HepatitisC. There may be potential for similar models for #PrEP or #HIV. #MercerChats

A2: The availability of #biosimilars for some blockbuster drugs has the potential to be a game changer. For the employer market, it’s a potential decrease in benefit cost. For the Medicaid market, it’s an opportunity for increased rebate negotiations. #MercerChats

@dr_salim_MD @Mercer_US Many in the industry are watching closely the recently announced FTC probe.

@Mercer_US It would be interesting to see what happens to #PBMS pharmacy benefits management services a FTC / government look into their function #mercerchats

A2: Manufacturers are pushing back on #340B through restrictions on sales to contract pharmacies despite pressure from federal regulators. Any #DrugPriceReform package needs to include a vision for a path forward on #340B. #MercerChats

@ShawnaKitt @april_lindquist @Mercer_US The pandemic created many, many challenges. But created opportunities for pharmacists to show the value they bring to the healthcare system!

@april_lindquist @Mercer_US A2: It will be exciting to see pharmacists and healthcare professionals work at the top of their licensure to support the upcoming challenges. We are already doing this with our Medicaid clients to identify opportunities to expand pharmacist patient care services. #MercerChats

A2: I think we are approaching a #340B crossroads. The program has grown exponentially over the last decade and now accounts for nearly 15% of total drug sales. #MercerChats 340B Program Continues to Grow While Contract Pharmacy Restrictions Take Effect - IQVIA

@april_lindquist @Mercer_US How do we provide programs that improve health rather than manage sickness?

@Mercer_US We can provide members access to programs that help lower medication costs or a lower total cost of care for chronic conditions. According to the CDC, 1 in 4 adults in the US have a chronic disease. It could impact each of us or our neighbors and loved ones. #mercerchats

A2: As we wind down from the #PHE, many individuals will move from Medicaid back to employer or exchange coverage. Governments, employers, and #PBMs need to coordinate to make the process seamless. #MercerChats

A1: Government and employer markets alike are exploring new innovations in financing high cost drugs. The new @CMS VBP rule may streamline the process for outcomes based contracting. #MercerChats

@samespinosa_mmc Drugs approved through the accelerated approval pathway average over $165,000 per patient per year. Harvard, Kesselheim paper highlights almost 90x increase in launch prices for new drugs since 2008 – Endpoints News (endpts.com) #HighCostDrugs #MercerChats

@SaraDrakeRx #addicted

A1: Despite uncertain efficacy and durability, patients, employers, and governments are being charged high prices for accelerated approval drugs. #MercerChats

A1: Government market is really beginning to question and redefine the role of the #PBM in #Medicaid managed care. States are seeking increased #PBMTransparency to better understand how #Medicaid pharmacy dollars are used. #MercerChats