Nuggets from day 1 of #Asembia2024! A lot of pulled threads from AMCP Annual, as well as some new learnings to help paint the fuller picture:
Key trends to monitor in the CGT and rare disease space:
- The booming category of self-insured employers (the TPA/stop-loss market is projected to grow to $800 billion by 2030)
- SPs taking on restrictive management tactics (79% of SPs are reported to be using an NDA block)
- Increased awareness that patient eligibility is expanding among CGT and rare disease products – rare disease is not so rare anymore
- Expect new demand for more holistic care (think clinical management on top of bread-and-butter distribution and access services) to produce greater value that matches these complex patient journeys
As far as the IRA goes..
While many aspects of program rollout (namely, drug price negotiation and Part D benefit redesign) remain uncertain, hard data is starting to emerge that provides some certainty to the unintended consequences we’ve been speculating about over the past year:
- Most payers are planning to react to higher financial liability through mechanisms like narrower formularies (73%), increase in utilization for specialty products (93%) and negotiating for higher rebate (75%)*
- While OOP smoothing via the Medicare Prescription Payment Plan will benefit many Part D beneficiaries, a significant proportion will still be left in the dust – such as the 75% of Medicare beneficiaries that have difficulty paying $2,000 to begin with, and the 77% that do not know about the OOP cap (especially problematic for an opt-in program)
- As far as the Part D benefit redesign goes, manufacturers play a key role in raising awareness and proactivity among patients and providers to help drive greater participation
*Presented as part of a series of data from Xcenda’s “Managed Care Network Survey,” to be officially unveiled in the coming months.
Valuate Health Consultancy
